Serious Illness Conversation Guide
The Serious Illness Conversation Guide is a one-page set of patient-tested questions that clinicians use to talk with seriously ill patients about their understanding of their illness, how much information they want, what may lie ahead, and what matters most to them. Ariadne Labs, a joint center for health systems innovation between Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, developed the guide as part of its Serious Illness Care Program, and the May 2023 revision moves through five sections: set up, assess, share, explore, and close. Ariadne Labs publishes it under a Creative Commons Attribution-NonCommercial-ShareAlike license.
Source: Ariadne Labs, Serious Illness Conversation Guide, May 2023
What separates the guide from a checklist is that it hands the clinician actual sentences, tested with patients rather than written for clinicians. It opens by asking permission, with wording along the lines of I would like to talk together about what is happening with your health and what matters to you, would this be ok. The assess section then asks the patient for their own understanding of what is happening and, separately, how much information about what might be ahead would be helpful to discuss today, which keeps the clinician from delivering a prognosis to someone who has not asked for one.
The share section is where the guide is most specific. It offers three framings depending on what is knowable, covering uncertainty, time, and function, and it builds them on a hope and worry structure: I hope you will feel as well as possible for a long time, and it is also possible that you could get sick quickly, and I think it is important that we prepare for that. Then it stops the clinician with a plain instruction to pause, allow silence, and validate and explore emotions before moving on.
The explore section asks about the patient's most important goals if their health worsens, their biggest worries, what gives them strength, which activities bring joy and meaning to their life, how much they would be willing to go through for the possibility of more time, and how much the people closest to them already know about their wishes. Ariadne Labs added a question about hopes to this section in the 2023 revision after patient input. The close section then summarizes what the clinician heard, makes a recommendation grounded in it, and checks how the plan sounds to the patient.
Programs teach the guide because fixed language is observable language: faculty can tell whether a learner asked the information-preference question or skipped it. The hard part is not the reading. Learners stall at the pause after the prognosis, where silence feels like failure, and at the recommendation in the close, where saying what they think is right feels like taking something away from the patient. Both improve with repeated practice against a patient who reacts.
What this looks like in a program
- Learners get further faster when the first run-throughs are low stakes, so the wording stops feeling borrowed before they use it with a real family.
- Because the guide documents the conversation as well as structuring it, the close section doubles as the note that the next clinician reads.
- Faculty can rehearse the pause after sharing prognosis, which is the step most often lost when a learner is anxious.
Last updated August 2026