The diagnosis of a serious, advanced illness may leave patients and families with many questions. As a health care professional, it is important for you to have discussions with patients and families about their illnesses and the kind of care available - what will help, what might help and what will not help.

You can begin this process by scheduling a meeting with a patient and his/her family or health care representative to outline the patient's goals of care. When planning this meeting, it is critical that you make sure the patient and his/her representatives understand the purpose of the meeting because the ensuing discussion can be very difficult and may include uncomfortable subjects. By explaining the reason for the meeting in advance, you are giving the patient and his/her representatives an opportunity to prepare their thoughts about these important issues.

When meeting with the patient and his/her family or health care representative, begin by determining how much they know about the patient's condition and ask if they have any questions. You can help the conversation progress by employing the following suggestions:

• Be attentive and empathetic to their emotional state, and as much as possible, proceed at their pace.
• Talk about what can be done first, and be sure to emphasize that there is always something that can be done, although it may not be curative.
• Make sure they understand the "big picture" before going on to specific issues.

Additional suggestions about how to lead the discussion about end-of-life care can be found in the LaPOST Handbook for Health Care Professionals in the Resources section.