Certain “forever words” should not be used in conversations with seriously ill patients, according to a group warning against language that silences patients’ questions, offends them or limits decision-making.

A doctor may say, “Your mother needs be intubated” or “she needs a transplant,” which can effectively prevent a patient or family from considering other pathways or options. In sentences such as “We can continue treatment, or we can just “doing supportive care” “simply” implies a value judgment, where a treatment is “suboptimal,” explained Rana Lee Adawi Awdish, MD, of Henry Ford Hospital in Detroit, and colleagues.

Therefore, “need” and “just” may be considered “never words” in certain contexts, the group said in a statement. Mayo Clinic Proceedings perspective document. The authors conducted a literature review on best practices for difficult conversations with patients and surveyed 20 clinicians within their professional networks to ask them what words or phrases they would never use with a patient.

Awdish and colleagues have advocated for alternative expressions that can instead invite open, patient- and family-centered conversations, better express the desire to provide care, offer realistic and humane support, invite deeper dialogue, and avoid letting hear that simple willpower can overcome an illness.

For example, an alternative to a “need” statement might be: “His heart is deteriorating. Can we talk about what that means and what to do next? This wording, the authors write, “signals an openness to shared decision-making, rather than issuing a unilateral directive. “More thoughtful and intentional communication redistributes power to the patient.”

The word “just” can be removed altogether, they said.

Awdish’s group provided more examples of never-words and alternative language:

• “There’s nothing else we can do” can become “Therapy “.
• The phrase “withdraw care” can become “We can focus on making him comfortable rather than persisting with the current treatment, which is not working.”
• “Do you want us to do everything?” can become “Let’s discuss the options available if the situation worsens.”
• “Everything will be fine” can become “I’m here to support you through this process.”
• Instead of “fight” or “fight” regarding the illness, use “We will face this difficult illness together.”

Having prepared readily available wording can help clinicians who lack time to rehearse shared goals across the continuum of care for each patient, the authors suggested.

For a clinician with good communication skills, “conversations are faster and more meaningful than if he or she is not skilled,” commented Robert Arnold, MD, of the University of Pittsburgh, experienced in teaching communication skills during difficult conversations with patients.

“I think doctors who care for seriously ill patients want to do a good job, and I think we should just give them the training and support that will help them do a good job,” said Arnold, who is also part from the board of directors of VitalTalk, an organization that teaches communication skills to clinicians.

“My general view is that we should focus on what we want people to do, rather than what we want them not to do,” he said. Page Med today. “Because if we spend all our time talking about what we don’t want them to do, from an educational point of view, that’s what they’ll remember.”

“You can teach certain phrases and yet you have to change them to fit your personality,” Arnold suggested. “I’ve said some things wrong before – I’ve probably said some of those ‘never say’ phrases, and yet if you say them carefully and carefully, sometimes it comes out better than you don’t think so.”

He recalls a time when he told a patient that he had “failed” at something. In response, the patient “looked at me and said, ‘I didn’t do it. It was the medicine. Your medicine didn’t work.'”

“I said, ‘Yeah, you’re right,'” Arnold continued. “We had a long-term relationship, and everything was good, and he trusted me enough that he could tell me when I said things he thought were stupid.”