TABLE 2.

Strategies for broaching difficult conversations related to goals of care

Theme	Examples
Summarizing illness course	All the best first-line medicines, right, the best second-line medicines, the best third-line medicines, the best fourth-line medicines, experimental medicines, right? So, we’ve done a lot, and we should be doing all of these things, right? Always with the goal to make your cancer go away… In the very, very, very beginning, when we first started, the goal was to cure, right, get rid of your cancer for ever and ever…[now] what we try to do is, we try to at least keep the cancer from growing.
Offering a warning shot	When do you continue or when do you stop and that’s a conversation that we, we will have to have. I know before we’ve had some discussions about what you would want to do in the setting that things come back again?…And I think we’re in the same place that we were before that we know there’s disease that we know we’re not going to be able to get rid of…and that doesn’t mean that we shouldn’t do anything at all, but I think it, I think it really gives you the option to decide what you want to do.
Asking “what do you want?”	How much of this do you want to go through or not? So you need to tell me everything you want to do. The next question that we need to talk about is what do you think would be the next steps? What would you like to do? Do you want to take a little break and think about it?
Eliciting “what’s important to you?”	And I don’t know how important it is for you and for [patient]’s dad and for her to be mostly at home, knowing that the ultimate outcome probably is not going to be significantly affected by what we do. I think it’s so important for you to start thinking about what’s important for you; because I don’t know what’s important for [patient]…And so, whatever we can do to do what’s best for you, we will do. A hundred times over, but I’m not going to pretend I know what that is, so, what I really want you to do is come up with a list of what’s important, ok? And then it helps us, it helps guide us, right?
Using “what ifs” to think ahead	What do we do if something catastrophic were to happen, right? Like if she were to stop breathing or if she were to have a seizure you cannot control, do you go to the emergency room?