Book overview
When the words run out, the patient pays.
Hospice and palliative care clinicians walk into the hardest conversations in medicine, and most were never trained for the talking part of the job. The clinical decisions are often clear. The communication that has to go around them is not. Families refuse hospice. Caregivers cannot pick up the morphine. Adult children arrive late and demand aggressive treatment. Goals of care plans made on Tuesday collapse by Friday. Somewhere between the evidence and the bedside, something keeps failing.
A practical guide built for the conversations you actually have.
This book takes the thirty year evidence base of motivational interviewing and translates it, at unprecedented depth, for hospice, palliative, and end of life care. It is not a theoretical text. It is a working clinician's field guide, grounded in real scenarios, written for nurses, physicians, nurse practitioners, social workers, chaplains, and interdisciplinary team members who want their hardest conversations to go better.
Twenty three chapters. Every tough conversation you face.
Learn to open questions that open hearts, affirm without false comfort, reflect in a way that shifts a room, and summarize without sealing what still needs saying. Walk through breaking bad news the slow way, sharing prognosis without false precision, introducing hospice without losing hope, and holding goals of care plans through the medical storm. Work the morphine refusal at midnight, the family meeting with eleven people, the late arriving son, the patient with dementia whose voice must be read through the family's memory, the child asking if they are going to die, and the cultural context where direct disclosure is not what the patient wants.
Skills that scale beyond you.
Close with chapters on your own grief, peer supervision that actually works, and how to build an MI team culture that outlasts any individual clinician. Includes seven appendices: a pocket card for the OARS skills, ten scripted scenarios with annotated responses, a full walk through of the Serious Illness Conversation Guide with MI overlays, a self assessment tool adapted from MITI fidelity coding, seven team practice exercises, four reproducible family handouts, and a curated reading list for continued learning.
What this book will change.
Your first open question in a new admission. Your pause after bad news. Your response when a caregiver says she cannot give the dose. Your ability to run a family meeting without it fragmenting. Your own sustainability in work that asks everything of you.
For clinicians new to hospice and for seasoned practitioners alike, the skills here will change how your next conversation ends.
