by Karen Knops, MD
This is an introduction to the A-S-C-E-N-D framework, offering six concrete steps as a guide to communicating with your medical team.
Life can change in an instant. With a new diagnosis, we can be plunged into a world of uncertainties, medical jargon, multiple clinicians, and sometimes life-changing decisions. “Patient” is not a title we choose but an experience we go through. Much of that experience is beyond our control, but we can control our response to it: the stories we tell ourselves, the way we communicate, and the degree to which we access the resources around us.
Good communication is the basis for diagnosis, helps us understand risks and benefits of options, and allows us to make informed decisions. While we cannot reduce the complexity of the human body, we can reduce the complexity of the conversation itself. Having a sense of how a doctor or other clinician might talk to us provides a level of control and clarity. A mental map or framework for what happens before, during, and after a visit can be a game-changer in important conversations.
Here’s what the framework covers – and why you should care:
Anticipation: Preparing for communication is both a physical and a mental challenge. Feeling and being prepared makes all the difference because there can be time pressures and emotions that interfere if we don’t deliberately set goals and stay focused on what we need from a visit. Anticipation includes the things we do before the visit, like arranging the time and place, and also the first moments of the visit that set the tone for what comes next.
Summary: For each topic that is discussed, there is usually an introduction of what is going to be discussed and why, plus some background information. Patients sometimes provide the summary of a new symptom or problem, and other times clinicians will bring up news or suggestions that they would like to use the visit to discuss.
Concerns: If it is not obvious from the summary, it is good to notice what is most important about the problem. Is there a specific hope or fear that is driving us to raise the issue? This helps us prioritize what needs further discussion.
Exploring: Often we need to dig deeper and talk in more detail before making a plan. Other times there may be emotions or confusion that should be acknowledged. If there are multiple options, we often need to explore the “what-ifs” about each option, and to understand how much choice we have over the plan.
Next Steps: Ideally, we never leave a visit without understanding the plan and knowing what comes next.
Document: Before we leave the visit, we take a moment to make sure we can access records from the visit and that we know how to get information we need about diagnosis, treatment and follow up.
Read on: “A” for Anticipation.