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

Multi-cultural Palliative Care