Chapter 8 212 4. psychological support: how much are you suffering from feeling overwhelmed? 5. goals of care: how much difficulty are you having getting medical care that fits with your goals? Patients are instructed to score their answers to these questions on a 0-10 Likert scale. The 5-SPEED is validated for use in patients with cancer visiting the ED.101 8.5.3 Thinking ahead to be able to act before things happen 1. A two-track approach In paragraph 8.4.2 is proposed that the Button illness trajectory model for patients with a haematological malignancy should be taught together with the more common used illness trajectories for patients with advanced cancer, organ failure and frailty. A twotrack approach is a concrete application of the Button model. Education about the twotrack approach in clinical practice can support non-specialist palliative care clinicians to discuss curative and palliative approaches to care with patients and their families. It is also possible to make arrangements with specialist palliative care clinicians, for example conducting the two-track approach together. In this case, the attending clinician can keep their role in the curative track, and the specialist palliative care clinician could be responsible for the palliative track. This may also help patients and family to bring up issues palliative care needs without having to worry that it will influence their curative treatment. It is important to note in education that initiating a palliative track is not only appropriate in patients who will certainly die soon; rather, patients with a possible lifethreatening illness can have palliative care needs while undergoing intensive curative treatment. A two-track approach should be advertised as an approach that can answer the needs of these vulnerable patients. 2. Discussing future scenarios Discussing future scenarios with patients and family is essential in providing proactive palliative care. However, current medical practice is mainly focused on the treatment of diseases (i.e., a more reactive approach). More attention should be invested in education and bedside teaching on prevention of unwanted outcomes, especially for clinicians providing generalist palliative care. A helpful model for initiating discussions about possible unfavourable outcomes in life-threatening illnesses and potentially curative treatments is the Goals of Car(e) model. Hui and Bruera used this model in an oncology clinic as part of integrated care. The Goals of Car(e) model uses a car as an analogy for the discussion of goals of care; not only the aspects of curative treatment, but also the aspects of supportive, palliative and hospice care should be discussed in order to prepare patients and family for a safe and pleasant road trip.104
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