Table 2.

Self-Assessed Communication Skills Learned for Use in Future Goals of Care and Treatment Preference Discussions

Skill assessment domain	Skill learned	% Respondentsa (n=29)
Communicating bad news	Start conversation by learning the family's understanding of patient's condition and expectations	100
	Avoid use of medical terminology and check for understanding	93
	Respond empathetically to patient/family's emotions	89
Discussing goals of care and preferences for life-sustaining treatment	Obtain an understanding of patient/family's perspectives, values, and goals	100
	Involve patient's primary care provider and others involved in the patient's care in determining the prognosis and goals of care	97
	Offer patient/family time to make decisions and the opportunity to readdress goals as patient's condition changes	96
	Frame treatment options (both ICU care and palliative care) in terms of positive choices by focusing on what will be done	90
	Inform patient or surrogate about the patient's prognosis	90
	Provide recommendation for an approach to care that would be consistent with patient's goals	86
	Ask about existing advance directives or knowledge about advance directives	86
	Explain role of surrogate to make decisions for patient based on substituted judgment	83
	Elicit and respect the patient/family's cultural and religious values that impact preferences for end-of-life treatment	69
	Suggest to patient/family a time-limited trial of life-sustaining interventions when appropriate	69
Determining code status preferences	Discuss goals of care and code status preferences with patients earlier in hospitalization and/or in outpatient setting given potential for patients to become seriously ill and lose decision making capacity	93
	Reach an agreement on goals of care and then discuss CPR preferences within context of established care goals	86
	Provide recommendation that weighs a patient's goals, prognosis, and chance of survival after CPR	79
	Clarify misconceptions and educate about risks and benefits of CPR (survival rates, complications) and alternatives to CPR	72
	Identify appropriate patients or surrogates with whom to discuss DNR order	72

^aIndicates % of respondents who marked each skill.

CPR, cardiopulmonary resuscitation; DNR, do-not-resuscitate; ICU, intensive care unit.