|RED-MAP Guide for Professionals (general guidance - updated 8/4/20)|
Try to build a relationship. Eye contact and tone matter when wearing a mask.
* Hello Mr X, my name is..., I am (your title). My role in the team looking after you is….
Outline reason for discussion. Check who should be involved and how best to do that.
* It is important for us to talk about your treatment and care. Who else do we need to speak to?
* Who should we talk to if you are more unwell and can't make decisions with us?
* I'm sorry we are having to speak on the phone not in person at this difficult time.
* We are doing our best to care for (person's name), but we are worried about her condition.
Find out what people know and expect. Explore initial questions or worries.
* I’ll explain what is happening but do you have any important questions or worries just now?
* Can I ask, what you know about your health problems and how you are now?
* Do you know what an infection like Coronavirus might mean for (person's name)?
Share information tailored to people's current understanding of the situation and how they are feeling.
Explain what we know in small chunks with pauses to check for a response.
Acknowledge and share uncertainty. Keep terms clear and simple. Kindness makes a big difference to people.
* You are less well because…. Yes, (person's name) is seriously ill...
* We hope you will improve with these treatments, but I am worried about how you are doing...
* If this treatment does not help or stops working, it is possible you will not get better...
* I am sorry to tell you but (person's name) is very ill now… He could die with this illness…
Pause to let people take in the information. Then, find out what matters to this person and family.
* Can we talk about what's important for you now and what we can do to help?
* Please tell us how you'd like to be cared for so we can do our best to look after you and your family.
Talk about realistic, available options for treatment, care and support for people.
Be honest and clear about what will not work or help. Options depend on the best place of care.
* For people who already depend on others for care at home or in a care home, it may be better to care for them in a familiar place when they are very ill or dying, if that's possible.
* Intensive care and ventilation do not help everyone. If someone is frail or unwell from other health conditions, it is better to care for them in a different way. Could we talk about how we can do that?
* Has anyone spoken about cardiopulmonary resuscitation or CPR? CPR is a treatment to restart the heart. CPR does not work when a person is in very poor health or dying. We record this information and focus on what can help.
* I wish there was more treatment we could give... Can we talk about what we can do?
* Whatever happens, we will continue to care for you and your family.
* We will give treatment and care to manage symptoms like breathlessness, pain or distress.
* It is difficult when a person and their family can't be together. We will do our best to help with this.
* We don't know how quickly things will change, but we will update you and you can phone us too.
Use available forms and online systems to record and share care plans and DNACPR decisions.
* We record and share plans we make for treatment and care so everyone knows about them.
Avoid language that can make people feel confused, abandoned or deprived of treatment and care.
There is ‘nothing more’ we can do. ‘Ceiling’ of treatment or care for a person.
We are ‘withdrawing’ treatment. Treatment is ‘futile’. Would you like to be resuscitated?
See: NHS Education for Scotland (NES) module – Shared decision-making, 2019
ANZICS guide to recommended language (available from RCP London: Acute care resource)