EMCrit Podcast Podcast 165 – The Semantics of End of Life Discussions with Ashley Shreves
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Jan 30, 2016 Ashley Shreves, an emergency physician specializing in palliative care and end-of-life communication. She discusses who to screen for goals-of-care talks and a short opening line to start conversations. She models asking about values, framing comfort-focused recommendations, translating goals into DNR/DNI orders, and handling upset or pragmatic family members.
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Start With 'I'm Really Worried' As A Screen
- Use two short screening lines: express worry then pause to see the family's response.
- If family answers with unwavering hope/faith, avoid lengthy ED goals discussions and document the plan for full interventions.
Ask Broadly About Illness And Doctor Conversations
- Begin with broad open questions: Ask how things have been and what doctors told them.
- This reveals caregivers' understanding of disease trajectory and their health literacy before discussing code status.
Ask What The Patient Would Say About Their Life
- Elicit the patient's values by asking what the patient would say seeing their current state.
- Use the surrogate's answers to align care: if they say the patient wouldn't want this life, propose refocusing care on comfort.
