Start with permission and a little time
Choose a time when the person feels able to talk and ask whether this is a good moment. You might say, “Could we talk about what would help you feel more supported?” Keep the first conversation manageable. There may be room for several shorter talks rather than one exhausting discussion.
- Listen before solving: Ask what is most difficult, what brings comfort, and what the person hopes for. Leave space for uncertainty or sadness without rushing to correct it.
- Include the right people: Ask whom the patient wants involved and what information they want shared. A trusted friend, chosen family member, interpreter, or faith leader may be helpful.
Connect choices to what matters to the patient
Families can love the same person and still have different ideas about treatment. When possible, ask the person directly about their priorities. Being comfortable enough to talk, spending time at home, or pursuing a particular treatment may matter differently to each individual.
- Ask what the options mean: Invite the clinician to explain what each choice could help with, what burdens it might bring, and what is likely to happen without it. Ask for plain language and time to consider the answer.
- Bring practical questions: Who will visit? What happens at night? What support will family need to provide? What costs could remain? These questions often make a frightening idea easier to understand.
When the person cannot speak for themselves
Tell the team about any advance directives, appointed decision-maker, and conversations the person had when they could express their wishes. The goal is to represent that person’s values. If their wishes are unknown, ask the medical team to help the appropriate decision-maker weigh what would serve their interests.
- Separate wishes from assumptions: Share what the person actually said or valued, and acknowledge what remains uncertain. Nobody has to pretend to know every answer.
- Ask for a family meeting: A clinician or social worker can help relatives hear the same information, clarify who has decision-making authority, and identify the next decision that needs attention.
Leave with a clear next step
An information visit can be a chance to ask questions. Ask what would happen before any enrollment decision and who can explain the paperwork. After the conversation, write down unresolved questions and agree on a person to follow up with the care team.
- Make communication accessible: Request an interpreter, written explanation, hearing accommodations, or another conversation when needed. Ask the team to repeat an explanation in different words if it remains unclear.
- Keep talking: Revisit preferences as the illness or priorities change. The Conversation Project offers free guides in English and Spanish to help families prepare and continue the discussion.
Sources
Read more from the organizations behind this guidance.