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Table 1 Specific topics of the MCA manual

From: Implementation of the milestones communication approach for patients with limited prognosis: evaluation of intervention fidelity

MCs

Period in disease trajectory

Specific topics of the manual

I

Diagnosis

• Warn patient that there is bad news (SPIKES)

• Open and honest statement of diagnosis and prognosis

• Discuss further procedure (diagnostic, therapy)

• Show limitations of therapy options

II

Stable disease

• Summarize last conversation

• Clarify how patients think about the disease (Prognostic awareness)

• Use stable disease to talk about advance care planning regarding end-of-life care.

• Define precautionary authorized representative

• Advance care planning can also be discussed later (depends of patient’s psychological condition)

III

Tumour progression

• Communicate tumour progression

• Check patient preferences

• Define new therapy goals regarding quality of life

• Bring in palliative care offers (IPOS)

• Question Prompt List

IV

Best supportive care

• Communicate the end of tumour centred treatment options

• Transition to best supportive care

• Include always patient preferences

General topics

In every conversation

• Organisation

• Physical condition

• Psychological condition

• Therapy

• Complementary medicine

• Patient preferences