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As a frontline #palliativecare physician, I am aware of the importance of discussing goals of care during a viral pandemic, such as #COVID19, when ventilators may be in short supply.

Here is a quick user’s guide for any health worker having this conversation (THREAD):
1/ On the topic of Critical Care, consider this: Would your pt accept being connected to a breathing machine, and not being able to talk, eat or speak? Would they be ok with dying in the ICU, or if they lived, discharge to a nursing home?
2/ It’s not always about living longer. Many frail seniors or those with incurable illness (also the highest risk re: COVID-19) are not looking to stretch out their lives, but are hopeful for dignity, comfort & QOL. Honouring these expectations is as important as saving lives.
3/ Kindly suggest what’s best. Many frail elders with life-limiting illness won’t benefit from intubation if they become very ill. Based on real-time clinical assessment, propose treatment that will help, not harm. And yes, it IS better to be honest and NOT give false hope!
4/ An interpreter isn't optional. Use a video app if available, to find out about an individual's understanding of their illness & prognosis. This way, you can truly obtain informed consent and directly improve a person's experience while respecting human rights.
5/ Even with PPE, human connection still matters. People are not just looking for facts, they are hoping for care. Taking that extra few minutes, sitting down at the bedside, and showing compassion & empathy makes all the difference, even in a crisis. /END
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