GUIDE FOR CARE AND SUPPORT DURING SERIOUS ILLNESS
Chapter 1: Communicating with your doctor: Questions and Answers
During Treatment: A 'Print and Take' Form of Important Questions and Information
Common questions to ask and important information to share with your health care provider when you are undergoing treatment for serious illness.
- How is my treatment going? As expected? __________________
______________________________________________________ - Will there be additional tests to determine the outcome of my past treatments? What will they be? What are they like? When will they be done? ______________________________________
______________________________________________________ - I want to describe how I've been since I last spoke with you:
- In General: ________________________________________
- Pain & Discomfort: (Scale of 1-10) ____________________
- Appetite/Nausea:____________________________________
- Constipation/Diarrhea:________________________________
- Sleep Pattern: _____________________________________
- Energy/Activities: __________________________________
- Medications Taken: ________________________________
- Result of Medications: _______________________________
- I have questions about: _________________________________
______________________________________________________ - What can be expected over the next week, 3-6 months?
______________________________________________________
______________________________________________________ - What medicines are you now prescribing for me? Do they have side effects?
______________________________________________________
______________________________________________________ - What other supportive services can you recommend? When would it be helpful to have a home health care referral?
______________________________________________________
______________________________________________________ - I understand my next appointments are:
______________________________________________________
______________________________________________________
Created by Compassionate Choices.
Next page: Chapter 1: During treatment: Record of Appointments