Here are several questions that you may add (optional) to the standard case write-up to enrich your understanding of the patient/family experience. These questions help you explore several domains including:

• Personal experiences of the patient and family
• Common symptoms experienced by the patient/family
• Life cycle issues at the end-of-life for the patient/family
• Reflections on your own issues as you explore the end of life with your patient/family

Patient/Primary Caregiver Experience

1. What is the patient’s and primary caregiver’s understanding of their illness?
2. What is most important to the patient and primary care giver right now?
3. How do the patient and primary caregiver create meaning out of their end-of-life experience?
   • What have you learned from this experience?
   • Have you gained anything from this experience?
   • Has anything positive come out of this experience?
4. What are the patient and primary caregivers previous experience with serious illness, and loss?
5. Who does the patient and caregiver include in their “family” and community?

Symptom Management

Please comment on whether your patient experienced any of the following symptoms and if so how were they addressed:

1. Pain
   • “physical”
   • “emotional/spiritual”
2. Shortness of breath
   • “physical”
   • “emotional”
3. Nausea
   • “phsycial”
   • “emotional”
4. Other symptoms?

Life Cycle Issues for the Patient and Caregiver

1. Are there issues of isolation for the patient and caregiver?
2. What are the greatest hopes of the patient and caregiver?
3. What are the greatest fears of the patient and caregiver?
4. What are the major losses experienced by the patient and caregiver?
   • How did they deal (grieve) their losses?
5. How are the patient and primary caregiver dependent on others?
   • How do they cope with their dependence?
6. Have the patient and caregiver participated in the following as a way of preparing for death?
   • Life Review?
   • Shared Important Stories
   • Shared Wisdom (important life lesions) with family and friends?
7. How did the patient and caregiver create “closure” between them?
   • With family members?
   • With friend

Student Self Reflection

Please comment on the following questions as they relate to your experience.

1. What are your greatest fears?
2. What are your past experiences with death and loss?
3. How do you “cope” with losses”
   • death?
4. What is the “meaning” of death to you?
5. What are the emotions, thoughts and reactions you experience as you “witness” the patient and caregivers grief and loss?
6. What qualities do you possess that help you be an effective physician to patients and families at the end of life?
7. What qualities do you possess that makes it difficult for you to be an effective physician to patients and families at the end of life?
8. How do you grieve?