​​A February 12, 2018, report from Kaiser Health News details how more facilities are training their practitioners on how to have important end-of-life conversations with seriously ill patients that detail the patients' goals, values, and prognoses. According to research cited in the article, fewer than one third of families of patients with end-stage diagnoses recall having such conversations at all, despite evidence that having these discussions can lead to better quality of life, fewer hospitalizations, more and earlier hospice care, and higher satisfaction for the patient compared with not having the conversations. Training methods mentioned in the article include Ariadne Labs' Serious Illness Conversation Guide, which has been used to train more than 6,500 clinicians worldwide, and the Continuum Project, a large-scale effort to quickly train clinicians to "have these conversations, document them and share what they learn with one another." Both forms of training involve loosely scripted role-playing where a clinician, working from prewritten dialogue, attempts to tell an actor (playing a patient) about a fatal diagnosis. According to Dr. Juliet Jacobsen, medical director of the Continuum Project, "The goal is to step back from day-to-day problem solving and talk about the patients' understanding of their illness, their hopes and worries, and the trajectory of their disease." 

HRC Recommends: To provide excellent end-of-life care, healthcare organizations must ensure that patients understand their condition, their prognosis, and their options and must elicit the patient's wishes. Potential strategies include training providers regarding how to discuss death and end-of-life care with patients and families, beginning discussions as early as possible, having repeated discussions as the patient's circumstances and wishes evolve, involving loved ones to the extent that the patient wishes to involve them, ensuring that patients understand their diagnosis and prognosis, discussing risks and benefits of therapeutic and palliative options, enlisting the help of experts in areas such as palliative care and behavioral health, and effectively communicating the patient's wishes.