Brigham and Women's Hospitals

Pal Care Communications

Common questions from family members of imminently dying patients

What they might say

Rationale

What you might say

How much longer do you think she has?

Clarify that time is what the person wants to know.

Speak in ranges.

It sounds like having a sense of how much time would be helpful? [Yes]

My sense is that she has hours to a few days.

Shouldn’t we give her some IV fluid?

Evidence does not support that hydration improves quality or length of life in dying patients.

Explore emotion and talk about what you are doing.

I can imagine it’s so hard seeing her like this. I worry extra fluid won’t help her live longer or better at this point. We are going to do all we can to ensure she’s comfortable.

Do you think she is in pain?

(patient appears comfortable)

May come from a fear of not being able to help their loved one. Tell them how you are assessing the patient.

I see how deeply you care about her. When I’m looking at her face and body, she appears calm and comfortable. We are going to keep monitoring closely.

Can she still hear us?

Encourage family (even if by phone) to talk with patient as they normally would.

We think so, and many believe that hearing is the last sense people retain. I’d encourage you to talk to her as you normally would.

Communication Skills Relevant to COVID-19

  1. VitalTalk is a nonprofit sociatol impact startup focused on communication skills training for serious illness

Scenario

What they might say

What you might say

Testing

Does this mean I have COVID-19?

We will need to test you with a nasal swab, and we will know the result by tomorrow. It is normal to feel stressed when you are waiting for results, so do things that help you keep your balance

Why does the test take so long?

The lab is doing them as fast as they can. I know it’s hard to wait.

No visitor policies

Are you saying that no one can visit me?

I know it is hard to not have visitors. The risk of spreading the virus is so high that I am sorry to say we cannot allow visitors. They will be in more danger if they come into the hospital. I wish things were different. You can use your phone, although I realize that is not quite the same.

How can you not let me in for a visit?

The risk of spreading the virus is so high that I am sorry to say we cannot allow visitors. We can help you be in contact electronically. I wish I could let you visit, because I know it’s important. Sadly, it is not possible now.

Illness getting worse

Is my grandfather going to make it?

I imagine you are scared. Here’s what I can say: because he is 90, and is already dealing with other illnesses, it is quite possible that he will not make it out of the hospital. Whatever happens, we will be here with him.

I’m scared.

This is such a tough situation. I think anyone would be scared. Could you share more with me?

Do I need to say my goodbyes?

I'm hoping that's not the case. And I worry time could indeed be short. What is most pressing on your mind?

Goals & Code Status

I want everything possible. I want to live.

We are doing everything we can. This is a tough situation. Could we step back for a moment so I can learn more about you? What do I need to know about you to do a better job taking care of you?

I don't want to end up being a vegetable or on a machine.

Thank you, it is very important for me to know that. Can you say more about what you mean?

I am not sure what my spouse wanted—we never spoke about it.

[spouse critically ill]

You know, many people find themselves in the same boat. This is a hard situation. To be honest, given his overall condition now, if we need to put him on a breathing machine or do CPR, he will not make it. The odds are just against us. My recommendation is that we accept that he will not live much longer and allow him to pass on peacefully. I suspect that may be hard to hear. What do you think?

Limited Resources

[In case of crisis and resource allocation]

Why can’t my 90 year old grandmother go to the ICU?

This is an extraordinary time. We are trying to use resources in a way that is fair for everyone. Your grandmother’s situation does not meet the criteria for the ICU today. I wish things were different.

Are you discriminating against her because she is old?

I can see how it might seem like that. No, we are not discriminating. We are using guidelines that were developed by people in this community to prepare for an event like this. The guidelines have been developed to consider all the pros and cons. I can see that you really care about her.

It sounds like you are rationing.

What we are doing is trying to spread out our resources in the best way possible. This is an extraordinary time. I wish we had more for every single person in this hospital.

Source: VitalTalk (Link to full VitalTalk COVID Tips Guide: https://www.vitaltalk.org/guides/covid-19-communication-skills/)