Table 3.

Application of the time-limited therapeutic trial model to a family discussion regarding shared decision care for a terminally ill patient with nondiabetic spontaneous hypoglycemia.17–19

Communication goal	What the care team would say.
Give the diagnosis and initiate discussion	Your loved one has hypoglycemia, which means her/his blood glucose level is so low that brain functions cannot be maintained, and we need to discuss the best way to care for her/him.
Give treatment options	We have a choice between raising the glucose level back to normal, which may require continuous IV drip because the patient cannot eat or drink OR focusing primarily on her/his comfort.
Introduce complications from treatment	We can raise the glucose level up, but because your loved one also has other discomforts that are difficult to treat, she/he might suffer even more when consciousness returns.
Elicit the patient’s value and family’s attitude	Your loved one is going to die in <1 week. If you know that she/he has any unfinished business, and/or you want to achieve lucid moments with her/him, a time-limited (short-term) treatment for her/his hypoglycemia can be provided. Acknowledge that family wishes may not be the same as the patient’s wishes.
Reassure to help the patient be comfortable	You are the proxy for the patient. If your wishes are to avoid glucose replacement, we can focus our efforts on helping her/him be comfortable and allow nature to take its course.
Reconcile goals	From your perspective, what is the best outcome that we could have for the patient in this situation? What do you think about that outcome?
Identify a timing at which the initial treatment decision can be re-evaluated	If your loved one is still unable to gain consciousness after treatment, or if she/he is very uncomfortable and suffering a lot, we should sit down and talk about all our options at that point.