Navigating and Communicating about Serious Illness and End of Life

This article examines how clinicians can help patients with serious illness integrate prognostic information both cognitively and emotionally into their understanding and planning. It emphasizes that prognostic awareness is a developmental process involving oscillations between intense hope and realism, and that such oscillation is normal. Communication strategies should move beyond scripted delivery of bad news to include iterative, empathic conversations over time that explore a patient’s hopes, worries, and capacity for adaptive coping. The authors argue that this evolving awareness enables better alignment of medical care with patient values, especially for end-of-life decisions. The article critiques the limitations of conventional advance care planning and advocates for a more fluid, longitudinal approach involving palliative care, primary care, and loved ones. It concludes with documentation recommendations that capture prognostic understanding, coping strategies, and patient priorities for shared decision-making.

This article examines how clinicians can help patients with serious illness integrate prognostic information both cognitively and emotionally into their understanding and planning. It emphasizes that prognostic awareness is a developmental process involving oscillations between intense hope and realism, and that such oscillation is normal. Communication strategies should move beyond scripted delivery of bad news to include iterative, empathic conversations over time that explore a patient’s hopes, worries, and capacity for adaptive coping. The authors argue that this evolving awareness enables better alignment of medical care with patient values, especially for end-of-life decisions. The article critiques the limitations of conventional advance care planning and advocates for a more fluid, longitudinal approach involving palliative care, primary care, and loved ones. It concludes with documentation recommendations that capture prognostic understanding, coping strategies, and patient priorities for shared decision-making.