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
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