6. Lastly, in this conversation the "where to from here" should be addressed.
Summarise the information you have given and what you perceive the main issues or problems to be now. Ask the patient to verify this and perhaps what all this means to them and add to the list if necessary. Then work through the issues and identify which ones you can help to resolve and those which you cannot. You and the patient may then prioritise the problems together and make a plan of action. You may need to explain why your action plan does not match the order of priorities, that is some problems are easier to deal with than others, or some are not resolvable.
It is also important to discuss with the patient how they might cope from now on, who might need to be involved, ie family, friends or health professionals. Where possible identify other sources of support with the patient.
Finally, summarise what has occurred, the plan of action, and invite the patient to ask any other questions. Make a time when you will see the patient again, that is, "I'll come past before I go home" or "I'll see you in the clinic in 2 weeks?"
This may sound simplistic and also rather long and laborious. It is not often that a conversation would include all the details of the "bad news" and a plan of action. Most of our patients are too sick and need some time to work through information in manageable portions, and as I said before this is guided by them.
In many palliative care situations the trusting relationship already exists between the health professional the patient is talking with, and so the dialogue flows fairly easily and
Presentation for the Life Planning Centre in Tokyo, Japan, 23 February 1997,
