Table 2.

Framework for a Goals of Care Discussion

Assess present understanding:

“Tell me what you understand about your illness.”

“What do you know about your cancer?”

“What have your doctors told you about your health?”

Develop an understanding of the patient's priorities:

“What is most important to you?”

“It's important to me to honor your wishes. To make the best recommendations, I need to understand your priorities better.”

“Are there things or projects you want to finish?”

“What is it that you really want from me/the health-care system/your doctors?”

“What could I do that would help you the most?”

Understand other influences on decision making

“Is your faith important to you?”

“Tell me about how your life philosophy guides how you make decisions.”

Assess your own perceptions and priorities of the patient's situation by asking yourself these questions:

How can I help reduce my patient's suffering?

How can I maximize his or her sense of control?

How will this procedure impact on the family (consider increased burden of care, financial strain, emotional stress)?

Am I acting in the best interest of my patient?

Am I helping?15