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Examples of Common Clinical Situations that are Emotionally Charged:
Common High-Stakes Situations
Common situations where the stakes are high and the communication process is intricate.
Breaking bad news
Communicating news about sudden and unexpected death of a loved one
Initial diagnosis of a serious life limiting / chronic life altering illness
Giving prognosis in a serious life limiting illness
Communicating news about worsening illness (SeeExamples below )
Discharge from any venue of care due to perceived medical futility
Referral to hospice for any terminal illness
Withdrawal or withholding of a therapeutic intervention
Emotionally charged discussions
DNR discussions
Advance directives
Family meetings
Requests for physician assisted suicide
Requests for palliative sedation
Discussion related to after-death tasks (handling the body, handling the paper work, handling the finances)
Death pronouncement
Organ donation discussions
Request for autopsy
Examples of Worsening Illness
Cancer
Failed chemotherapy, surgery, radiation
End stage heart disease
Advanced CAD not amenable to any intervention, cannot be placed on transplant list due to various reasons, high risk of sudden death, failed ablation, failed cardioversion, need for life long coumadin
End stage kidney disease
Initiating dialysis, failing transplant, not eligible for a transplant
End stage lung disease
New diagnosis of refractory lung illness, need to resect lung, need for chronic supplemental oxygen