Clinical Application of ASCEND: A Pathway to Higher Ground for Communication

Dear Editor:

K. Knops and S. Lamba focus on the acronym ASCEND ¹ (Anticipation, Summary, Concerns, Explore goals/Explain recommendations, Next steps, Documentation) as mnemonic pathway to higher ground for communication. ²

In general practice, this acronym is useful in different kinds of encounters: in individual contacts or with family members and in care teams, in interdisciplinary prior and follow-up meetings, in circumstances with a probability of conflict situations (as in your presented case).

The ASCEND tool is very useful especially in the context of palliative care and in that sense we believe that the first letter of the acronym A for Anticipation - a form of reflexion - and advance preparation deserves more elaboration. Other initial goals are: to achieve a common perception of the problem (ask about what the patient-environment already knows and understands); anticipate what has not been talked about; minimize isolation, aloneness, and reassure about nonabandonment … all skills that are important in delivering difficult news and in the clinical application of ASCEND. ASCEND is an opportunity for students to learn and demonstrate the requisite knowledge and skills concerning a core set of critical communication encounters. ³