PAUSE

GOALS OF CARE, EARLY IN THE ILLNESS

STEP

WHAT YOU SAY OR DO

PAUSE,

make the time

“There is something I’d like to put on our agenda today.”

Take a moment to introduce the topic.

ASK

permission and explain why.

“I would like your opinion on something. Occasionally one of my patients gets sick suddenly and I can’t talk to them.”

“Then I worry that I can’t provide the best care for them.”

“For example, one of my patients told me that they would never want to be a vegetable. That’s very important for me to know, even when that person is far from being that sick.”

“What do you think about that?”

UNDERSTAND

big picture values.

“Have you ever heard about advance directives or living wills?”

“If the disease was getting worse and might take your life, what would be most important to you?”

“Some people think that we should focus on comfort, others say adding days to your life is the most important. What do you think?”

SUGGEST

choosing a surrogate.

“Have you ever thought about who would be the best person to make medical decisions if you were too sick to make them yourself?”

EXPECT

emotion respond empathically.

“I can see this is making you feel concerned.” [names the emotion]

“What I am hearing you say is you want to keep fighting.” [Reflects the patient’s words back]

This content also references Address Goals of Care.