EC4H Realistic Conversations: Skills to support TEP conversations

Workshop overview

Mr Clark, aged 78, has prostate cancer with extensive bone metastases. He was admitted to the ward for assessment due to deteriorating health. Mr Clark fell overnight. The consultant phones Mr Clark’s son to inform him and discuss further treatment plans

This session will demonstrate:

Treatment Escalation Plans“A Treatment Escalation Plan (TEP) is a communication tool which is helpful in hospital when a person with serious illness has the potential for acute deterioration or may be coming towards the end of their life. Sometimes doing everything possible may actually lead to harm – to more suffering and distress rather than less – and without any particular gain. What can be done and what should be done may not necessarily be the same thing. Treatment Escalation Plans should be discussed and made based on personalised realistic goals rather than ‘one size fits all’ treatment.

Crucially, a TEP provides on-call hospital staff with immediately accessible guidance about how to respond to an individual in times of crisis, especially out of hours and at weekends. A TEP becomes particularly important when there is agreement that interventions or referrals for more intensive care that are contrary to a person’s wishes or are futile or burdensome should not be undertaken. Equally in many patients who may have an agreed DNACPR, a TEP clarifies all the treatments and care that should continue.”

In severe illness quality of care becomes more important than ever but the goals of treatment are different for different people. Hospital care is becoming more and more complex and both patients and their families are particularly vulnerable to the impact of errors, harms and poor communication. It is especially important for hospital staff to understand and respect the values and preferences of the people they are looking after and to discuss with them a plan for emergencies.

Knowing how the plans should be sensitively discussed and used is important and this session provides a framework for such conversation

Learning outcomes

Workshop participants will:

Review their current practice in communication about treatment related decision-making and consent

Working together, they will practice more effective ways to:

• Communicate information about risk clearly and effectively with a wide range of patients and families.
• Communicate the benefits and limitations of treatment in a balanced way.
• Manage patients and families who have unrealistic expectations of treatment and outcomes.
• Use decision aids to support effective communication and complex shared decision-making
• Respond to complaints about clinical decision-making and consent