Fifteen Eighty Four

Academic perspectives from Cambridge University Press


A Practical Guide to Discussing What Matters Most with Seriously Ill Patients

Elise C. Carey, Gordon J. Wood, Holly B. Yang

Navigating Communication with Seriously Ill Patients, Balancing Honesty with Empathy and Hope – The VitalTalk Method is a book written for all clinicians who want to communicate better with seriously ill patients and their family members. This book describes and deconstructs communication to help the reader enhance their own skills, teach others, and, we hope, find deeper meaning in their work.

Why we wrote this book:

Challenging patient encounters frustrate many of us daily. So, our primary goal in writing this book is practical – we want to give clinicians the tools and skills they need to communicate with patients more effectively so they can learn what matters most to them, support patients and their families as they navigate life-changing diagnoses and build deeper relationships with the patients and families they care for.  We hope to empower and reinvigorate clinicians by giving them tools that help them reconnect to what brought them to medicine in the first place. By highlighting discrete skills and providing tools for ongoing growth, we hope to demonstrate that change is possible!  We can all improve our communication skills with deliberate practice, feedback, and reflection.

This book shares lessons learned from our experience in founding and leading VitalTalk, a nonprofit organization whose mission is to integrate evidence-based serious illness communication skills into healthcare practice through an engaged network of trained faculty.  Based on teaching approaches refined over the last 20 years, VitalTalk seeks to ensure that every seriously ill patient will be surrounded by clinicians who can skillfully discuss what matters most and match care to values.  To date, VitalTalk has trained over 1,000 faculty in how to teach communication skills and has provided communication skills training to over 35,000 clinicians.  Learners who have attended our courses tell us that these communication skills have changed how they approach patients, how they navigate emotional moments, and, most importantly, how they feel about their work. We hope the book can bring these outcomes to a wider audience.

What’s new:

In this second edition, we’ve changed the flow of the book to follow a progression that parallels how clinicians frequently work with seriously ill patients. We’ve added new content, including sections with tips on foundational communication skills (Chapter 2), helping patients plan for the future (Chapter 5), and what to do when you are really stuck (Chapter 12).  We have also expanded information on working through conflicts with colleagues (Chapter 11).  Throughout, we have included the latest cognitive roadmaps developed and refined in VitalTalk workshops.

We’ve updated existing content to include recent advances from the literature and modern practice such as the concept of cultivating prognostic awareness and how that impacts how we talk with patients.  We have included communication skills needed for telehealth and other serious illness communication lessons learned from the COVID-19 pandemic.  We have highlighted practice innovations in serious illness communication learned from both within and outside of our VitalTalk community. Throughout the book, we emphasize the roles privilege, race, and power play in the medical encounter and offer some tools that we hope will help clinicians navigate this landscape with greater self-awareness and sensitivity.  Taken together, we hope these updates will allow this book to serve as an even more valuable guide to every clinician who wants to improve their skills in communicating with seriously ill patients and their families.

Title: Navigating Communication with Seriously Ill Patients

Authors: Dr Robert M. Arnold, Dr Anthony L. Back, Dr Elise C. Carey, Professor James A. Tulsky, Dr Gordon J. Wood and Dr Holly B. Yang

ISBN: 9781108925853

About The Authors

Elise C. Carey

Elise C. Carey, MD, FACP, FAAHPM is Associate Professor of Medicine at Mayo Clinic in Rochester, Minnesota and the Education & Faculty Development Chair for the Mayo Clinic Palliat...

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Gordon J. Wood

Gordon J. Wood, MD, MSCI, FAAHPM is Associate Professor of Medicine and Medical Education in the Section of Palliative Medicine at Northwestern University Feinberg School of Medici...

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Holly B. Yang

Holly B. Yang MD MSHPEd, HMDC, FACP, FAAHPM is the Scripps Health Co-Director of the UCSD/Scripps Health Hospice and Palliative Medicine Fellowship Program, and a Voluntary Associa...

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