Initiating the Conversation

In developing this guide, we assume you are dealing with a competent patient. If the patient is incapable, the same approach can be used with the substitute decision maker instead of the patient

For patients in Category #1, conduct a cursory scan of issues that might affect goals of care. For example, after assessing severity of current illness and pre-illness function and quality of life, you may say something like "There is no medical reason why we would not offer you the full extent and types of treatment at our disposal. However, given your own values, should we be aware of limits that you would provide on the types or extent of care that you would like to receive?"

For patients in Category #3, the focus is on assessing illness understanding, communicating prognosis, and assessing patient/family supportive needs. A good opening line is "What have the previous doctors told you about what has been going on?"

Depending on the response to the above question, parts of the following pathway will be needed to move to plans for end-of-life care.

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