The "Living Well" structured interview is included as an Appendix to the Facilitator's Manual.
This discussion starts by simply asking the person, "At this point, given your medical condition, how could we (the health professionals) help you live well?" The point of this planning discussion is goal setting and establishing medical and non-medical treatment priorities.
In La Crosse the structured interview was integrated as a pilot project to explore the impact of this type of planning. The result was a very positive response from patients and an encouraging set of outcomes. Structured interviews were conducted with 51 patients with metastatic cancer, in most cases many months before death. In this group, 95 percent of patients felt that the discussion was meaningful. Only a few patients who were approached refused to participate. When asked how the interview was helpful, 52 percent said it improved communication with either their family or physician; 38 percent said it helped them emotionally; 30 percent said it helped them identify resources; 18 percent felt better that someone cared and 13 percent said it helped them set goals. In the three months that followed the structured interviews, four percent who died did not receive palliative services and after one year the median length of hospice admission was 42 days for those in the pilot compared to 20 days to other patients admitted to hospice during the same time.
"In the future, as new decisions about healthcare may be faced, it will be of great value to know your views and thoughts. We know that views and thought can vary widely among patients, especially when an illness may not be curable. We also know that discussing preferences about future care can be difficult. These questions may help clarify your views and help discuss them with others."
"We also hope that reflecting on the following questions will assure that all future decisions and discussions will be made in response to your views and values and help you live well. This process is one way we use to make sure you get the best care possible."
1. Which activities or experiences are most important for you to maintain or fulfill for you to feel your life has quality...for you to live well? (What makes you happy?)
2. What fears or worries do you have about your illness or medical care?
3. If you have to choose between living longer and quality of life, how would you approach this balance?
4. Are there any special events/activities that you are looking forward to?
5. What needs or services would you like to discuss?
6. Do you want information about anything related to your present or future care?
7. What sustains you when you face serious challenges in life?
8. Do you have any religious or spiritual beliefs that are important to you?
9. In what way do you feel you could make this time especially meaningful to you?
10. What do you hope most for those closest to you?
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