Conflict Resolution II: Principled Negotiation #184

Kendall, Adam R.; Arnold, Robert M.

doi:10.1089/jpm.2008.9882

Journal of Palliative Medicine

2008

DOI: 10.1089/jpm.2008.9882

|View full text |Cite

Conflict Resolution II: Principled Negotiation #184

Adam R. Kendall

Robert M. Arnold²

Help me understand this report

Search citation statements

Order By: Relevance

Paper Sections

Select...

Citation Types

Supporting

Mentioning

Contrasting

Year Published

2019

Publication Types

Select...

Article2

Relationship

Self Cite0

Independent2

Authors

Journals

Cited by 2 publications

(3 citation statements)

References 1 publication

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The problem is not a patient who cannot accept the prognosis, nor is it the pessimistic clinician who has given up hope. The problem is the disease, which is advancing despite everyone’s efforts . To guide patients through a serious illness, we must recognize our own limitations about knowing the future and join patients in a more humble position of hoping and worrying together.…”

mentioning

confidence: 99%

Softening Our Approach to Discussing Prognosis

Lakin

Jacobsen

2019

JAMA Intern Med

View full text Add to dashboard Cite

We tend to cringe when we hear "So, how much time do I have, doc?" Yet prognostic discussions are a core skill of being a compassionate physician, preparing patients and families to live with serious illnesses, and enabling informed medical and personal decisions. The first challenge of prognostic communication is the inherent and unavoidable uncertainty, that the exact trajectory of health (or illness) is unknowable. Thus, clinicians are inaccurate prognosticators, overestimating by up to a factor of 5. 1 We have difficulty making accurate short-term time-based prognostic estimates for common diseases, such as congestive heart failure, and can be off by as much as 1 to 2 years. 2 Compounding this uncertainty, we worry about upsetting our patients with too much or unwanted information. On one hand, patients say that they want to know their prognosis and report that it is one of their highest priorities. 3 On the other hand, patients also say that they are unsure about how much they want to know and give mixed messages about how much they want to talk about it. 4 As one patient said, "I ask the question, and then I don't want to know the answer. But the question is out there, and then I am devastated." Uncertain about the information and not wanting to cause emotional harm, we hesitate to talk with patients about their futures. We watch colleagues hesitate with statements such as "Well, I don't have a crystal ball" or "You know I can't tell you that," or "Only God knows," or "We are very bad at predicting this sort of thing." But we also worry that our patients do not have the prognostic information that they need, however imprecise. And perhaps worse, we worry that patients perceive that we cannot handle the tough discussions they need from us.We propose that to succeed in prognostic communication, what clinicians most need is not precision about the time ahead or the fortitude to discuss it, but rather a softened approach. To do so, we recommend communicating a prognosis by pairing our hopes and worries: 5 "I am hoping that you have a long time to live with your heart disease and I am also worried that the time may be short, as short as a few years." We have found this approach to be popular with colleagues-they like it and incorporate it into practice quickly.It works well for several reasons. First, by expressing hopes and worries, clinicians incorporate "I" statements, such as "I am hoping" or "I am worried." These statements share the feelings, beliefs, or values of the clinician rather than an objective prediction of the future. Originating in Carl Roger's nondirective approach to therapy and the parenting literature of the 1960s, 6 "I" statements acknowledge that the viewpoint expressed is personal. They contrast with "you" statements, which focus on the person being spoken to: "You

show abstract

mentioning

confidence: 99%

Softening Our Approach to Discussing Prognosis

Lakin

Jacobsen

2019

JAMA Intern Med

View full text Add to dashboard Cite

show abstract

“…The problem is the disease, which is advancing despite everyone's efforts. 7 To guide patients through a serious illness, we must recognize our own limitations about knowing the future and join patients in a more humble position of hoping and worrying together.In summary, pairing hope and worry as "I" statements enables clinicians, patients, and families who are facing serious illnesses to find a shared language for prognosis. This language is important because serious illnesses give us a lot to talk about.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

Green Chicago River on St Patrick’s Day

2019

JAMA Intern Med

View full text Add to dashboard Cite

cian who has given up hope. The problem is the disease, which is advancing despite everyone's efforts. 7 To guide patients through a serious illness, we must recognize our own limitations about knowing the future and join patients in a more humble position of hoping and worrying together.In summary, pairing hope and worry as "I" statements enables clinicians, patients, and families who are facing serious illnesses to find a shared language for prognosis. This language is important because serious illnesses give us a lot to talk about. Like running a race, living with a serious illness requires preparation. Knowing the length of the race is only one part of planning. The grade, the curves, the bumps, the changes in terrain, the texture of the trail, where the crowds will stand to infuse energy, the other people running the race-these factors are as important as the distance. Equally important is how these factors change over the course. Will it be steep and slow up front, in the middle, or at the end? By releasing our focus on knowing and predicting the future and instead sharing our hopes and worries, we can begin these discussions.

show abstract

scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.

Contact Info

hi@scite.ai

10624 S. Eastern Ave., Ste. A-614

Henderson, NV 89052, USA

Blog Terms and Conditions API Terms Privacy Policy Contact Cookie Preferences Do Not Sell or Share My Personal Information

Made with 💙 for researchers

Part of the Research Solutions Family.

Conflict Resolution II: Principled Negotiation #184

Cited by 2 publications

References 1 publication

Softening Our Approach to Discussing Prognosis

Softening Our Approach to Discussing Prognosis

Green Chicago River on St Patrick’s Day

Contact Info

Product

Resources

About