Table 2.

Main Categories of Literature

Communication Unclear understanding of prognosis Need for information and knowledge sharing Need to clarify care goals Who to contact for needs Honoring preferences	Symptom Management Unmet physical, psychological, spiritual, social needs What to expect (preparation) How to manage (education) Caregiver support
Care Continuity & Rehospitalization Care coordination Access to specialized care after hospitalization Trajectory (stable with continued care, unstable without continued care) Costs	Survival Need to determine life expectancy for hospital discharge planning High mortality rates reported for those discharged to nursing homes.