Best case, worst case.

This is a communication framework developed to help surgeons discuss the risks and benefits, and most likely outcomes, of different interventions with their patients. When used well, it’s an effective way of presenting outcomes in a narrative manner that’s easier to comprehend in the context of one’s goals and values, and helps formulate a recommendation based on these values.

One of the things to remember with the Best Case, Worst Case framework is to never assume you know what your patient considers “best” and “worst.”

I met a patient recently who was no longer interested in chemotherapy. I wondered if hospice might help him stay comfortable, and spend more time at home with his family. To me, this sounded like a Best Case scenario. But he didn’t like the sound of this. To him, the Best Case scenario was a sudden death, preferably sooner rather than later, ideally before he even left my clinic. He was ready now, why wait any longer?

It was a good reminder that there’s no universal definition of what’s best or worst – this is why exploring your patient’s unique goals and values is so important!

To learn more about Best Case, Worst Case check out this great site from the University of Wisconsin.