Thanks for this question, it's really important. This question comes up in two distinct scenarios: when a person is first diagnosed and when a person is nearing the end of her life. Let's talk about them in sequence. 1). At diagnosis: When a person is first diagnosed, this question is part of "g...

First – thanks for bringing communication to the surface. A lot of people struggle with this question. As VitalTalk volunteer faculty, I can offer the following evidence-based framework. (This reply is my own and not a statement from the VitalTalk non-profit organization).When the patient...

I would add one thing to the above discussion, which is to ask "why." Both these questions "is this terminal?" and similar prognostic question "how much time do I have?" require pause and contemplation on our part as well as the patients. I ask myself, why is the question being asked? What would be...

I usually explain to the patient what metastatic disease is and what the goals of treatment are. Something like, "When a cancer starts in one place and goes somewhere else, we cannot get rid of it altogether. Our goal is to control the cancer, prevent it from causing you problems like pain, and give...

I’m honest with them. I tell them that I’m sometimes wrong. I try to avoid telling them how much time they have with any precision because it’s hard to predict. I also discuss hospice. I tell them that I could be wrong. When asked, I give an estimate of lifespan. My patients have m...

My response to the specific question from a patient, "Is this terminal?" is "It's highly likely that this is the thing that's going to shorten your life." That a) honestly answers the question, and b) allows her or him to quickly move on to the subsequent questions that matter the most to their indi...

Wonderful responses. Like most, my approach has evolved over time with education, clinical experience, and exposure to the wisdom of respected clinicians. I usually focus on prognosis delivery and assurance of continuity of care as two main themes. Regarding prognosis delivery, I note that the phy...

I have learned a great deal from theMednet thread, and I thank everyone, and in particular, Dr. @Tyler Johnson, for his wonderful response. Similar to others, my approach to these types of conversations has evolved as I have gained experience in practice. In fact, these conversations take practice, ...