1. Determine the question you are being asked to address and the urgency of the consultation.
2. Review the patient's medical record, including laboratory tests, x-ray reports, and consultants' opinions, to determine the patient's major medical problems and prognosis. Perform a history including psychosocial and spiritual assessment and physical examination to assess pain and other symptoms, the patient's values and treatment preferences, and physical, psychosocial, and spiritual needs.
3. According to state law, determine the appropriate decision-maker for the patient. With the patient's permission if the patient has decision-making capacity, talk to the patient's family to learn their perspective on the patient's illness, their values and concerns, and their psychosocial and spiritual needs.
4. As appropriate, conduct a patient-family conference with members of the treating health care team to determine goals of treatment and to agree on a plan of care. Involve a social worker in the conference to aid with psychosocial support for the patient/family, completion of advance directive documents, and post-discharge arrangements. Include a chaplain in the conference to provide psychosocial and spiritual support for the patient and family.
5. Consistent with the agreement reached in the patient-family conference, document your recommendations for pain and symptom management, and continuing psychosocial and spiritual support for the patient and family in the patient's medical record. If the patient/family wanted a second opinion regarding treatment options or prognosis, recommend such consultation. If despite the conference, conflict between the patient/family and the treating team persists, recommend an ethics consultation.
6. Follow up with the patient and family after the initial consultation to continue to assist with pain and symptom management, goal clarification, psychosocial and spiritual support, and disposition.
7. Evaluate the process to see how it could be improved.