Box 3.

Framework for defining care goals when patients are not doing well

Invitation to assess readiness to have conversation:
 “Can we talk about how things have been going?”
Using open-ended “big picture” questions to assess care goals and preferences:
 “What is life like outside the hospital?”
 “What is most important to you now?”
 “What are you hoping for?”
Outline barriers to decision-making:
 “As you think about the future what worries you the most?”
Propose a plan that meets the patient’s goals:
 “Now that I understand your situation, can I make a recommendation?”
Reassure your commitment:
 “I’ll stick with you through this”