Understanding Formulation in Patient Care

Denial. Substance use. Venting. Positive reframing. Humor. Acceptance. All of these are ways we cope with stressful situations. Some we may consider healthy or unhealthy coping strategies, but are they really that easy to categorize? Isn’t it more important to ask whether a particular coping behavior is adaptive or not for a particular person,in a particular time or situation?

We are going to tackle this question and so many more about coping on this week's podcast with Dani Chammas, a recurring GeriPal guest, psychiatrist, and palliative care doc at UCSF, and Amanda Moment, a Palliative Care Social Worker at Brigham and Women's Cancer Center. There are so many take-home points for me on this podcast, including this one on a framework for assessing coping in serious illness:

1. nonjudgmentally observe their coping

2. wonder about the impacts of their coping

3. prioritize helping patients maintain their psychological integrity

4. mindfully think through how we can serve their coping in ways that they can tolerate, always calibrating based on the person, the moment, and the setting in front of us.

Here are some more resources we’ve discussed in the podcast

• Dani’s NEJM article on coping: “Should I Laugh at That? Coping in the Setting of Serious Illness”

• Dani’s GeriPal podcast with us on “Improving Serious Illness Communication By Developing Formulations”

• A great journal article on “Formulation in Palliative Care: Elevating Our Potential for Therapeutic Communication”

• A study on how palliative care may work by enhancing patients’ ability to access adaptive coping - “Role of Patient Coping Strategies in Understanding the Effects of Early Palliative Care on Quality of Life and Mood

** NOTE: To claim CME credit for this episode, click here **