TABLE 1.

Modular Blueprint for Discussing Death, Dying, and End-of-Life Goals of Care

Strategy	Skills	Process Tasks
Establish the relationship.	Endorse question asking. Check patient and family understanding. Invite patient and family agenda items.	Ensure privacy and comfort. Make partnership statements.
Develop an accurate, shared understanding of the patient’s situation, including disease features, prognosis without treatment, and psychosocial needs and concerns.	Check patient and family understanding. Clarify. Check patient preference information.	Discuss expectations. Correct misunderstandings.
Support patients and their family following the physician’s discussion of death and dying and end-of-life goals.	Take stock. Ask open questions. Check patient understanding. Endorse question asking. Clarify. Restate.	Tailor to the patient’s preferences for level of detail. Ask if a discussion of the dying process would be helpful. Describe the natural dying process. Avoid jargon and euphemisms. Consider spiritual or religious needs. Address specific cultural needs.
Respond empathically to patient’s emotional response.	Ask open questions. Encourage expression of feelings. Acknowledge. Validate. Normalize. Praise patient efforts.	Allow time to integrate and allow for silence. Offer tissues. Touch, when appropriate.
Close the conversation.	Take stock. Summarize. Check patient understanding. Make partnership statements.	Emphasize the quality of symptom control and goals of care—a peaceful, natural death. Affirm courage. Remind about team availability.

Note. The goal is to support patients and their family members during discussions and the decision-making process regarding end-of-life care.