Communication is the most important, rewarding, and challenging aspect of healing and caring for others. Patients and their families feel the frustration and powerlessness that come with poor communication - even in everyday health care visits. Skilled communication is a final common pathway in creating a meaningful end of life experience. It is the cornerstone of the process of end-of-life planning, and becomes the foundation of shared resilience in the face of the unplanned.
The "ASCEND" pathway was developed over ten years ago, building on expert recommendations and research in advanced care planning, breaking bad news, and other clinical communication. The pathway expanded on existing models by emphasizing universal elements of communication - allowing the techniques to be used in a wide range of discussions. Simple language was used in the model, intuitive for health care workers and for patients and families faced with serious illness. The existence of a "patient-centered" version of the pathway allowed it to be posted in a waiting room, supporting both clinician and patient in communication.
The name "ASCEND" is not accidental. Its connotations of achievement and enlightenment are vital for countering fears of discussing difficult topics, such as illness and death. Imagery of climbing, navigating a path, and rising above obstacles - images that resonate with the deepest human instincts to persevere - are a part of "ASCEND" materials and training. Users learn that co-creating a narrative is its own journey, a form of bravery. The model has been used to facilitate training of clinicians and the community, and has been adapted as an advanced care planning workshop for the public. To "ASCEND" is to go upstream - the process can be used by a lay person to discuss fears about illness (or even fears about talking about illness) with family, easing the first steps towards meaningful discussion days, months, or years later.
Far from competing with formal communication training programs, the pathway complements existing, well-established curricula, and creates a scaffold for further education. Because the techniques can be used to discuss less emotional, "everyday" topics such as informed consent or discharge planning, they can be taught and practiced very early in medical education. Used in an office or hospital, "ASCEND" patient and clinician materials are designed to trigger recall and use of communication skills. "ASCEND" encourages both clinicians and patients to start where we are, knowing that the only way to reach our goal is to begin with a first step.