The 4 questions framework was developed by Coastal Community of Care in VCH. These questions help teams learn about a person's understanding of their illness, priorities, hopes and fears.
Download the Long-Term care four-question framework:
This framework assists clinicians navigate conversations with family members who voice a concern or notice a change in a resident's health.
Download the AFIRM framework:
Conversation Don'ts: Things to avoid
Conversation Dos: Instead...try these
Do not provide facts in response to emotions. Do not assume that you know the reason for their emotions.
Do not make the conversation more about what you have to share.
Do not user formal medical terminiology.
Use vocabulary appropriate to the patient's level of education and understanding of their condition. (E.g. breathing machine with a tube down your throat rather than intubation and mechanical ventilation).
Check that you have understood their responses correctly by paraphrasing what you've heard them say.
Do not give false hope or make premature promises.
Do not provide patient with a list of menu options.
Do not make the conversation about life or death.
Do not talk down to patients or convey closed body language.