Critical care network, palliative and end-of-life section
Discussing code status with families of critically ill patients
Discussing code status with patients is complex and emotional, especially when critically ill.
Dr. Syed Nazeer Mahmood
The complexity further increases when these conversations have to take place with family members.
Anne Kelemen, LCSW
Here are some practical tips to help have these conversations in a concise and compassionate manner.
Introduction
- Introduce yourself, and make sure to identify the correct decision-maker.
- Get to know the patient.
–What kind of person are they?
–What brings them joy?
- Find out what the family knows about the current clinical condition of their family member.
–What have you been hearing from the medical team?
–What are you worried about?
Update
- Fill in the gaps – update them on the clinical condition and ongoing management.
- Discuss how you think they will respond to current management and further management options.
- Allow them to process the information.
Provide a medical recommendation
- Example: We are worried he might die, and if his heart stops, interventions like CPR or intubation would not work, and we would not recommend them.
- Do not pressure for a decision right away. (You can say “We do not need a decision today, so please take time to process this information.”)
Respond to emotions
- I can’t image how hard this must be.
- Offer chaplain services if that is important to them.
Things to avoid
- Avoid aggressive language.
–We will have to pound on their chest, break ribs.
–They would be suffering.
- Blaming or judgmental language.
While this complex discussion r equires individualization, these tips will help set a framework for goals of care conversations that lead to high quality care for patients that aligns with their goals.
Reference
Goldfish and Rosielle. Language for Routine Code Status Discussions, Fast Facts and Concepts #365, Palliative Care Network of Wisconsin.
Syed Nazeer Mahmood, MD
Fellow-in-Training Member
Anne Kelemen, LCSW
Member-at-Large