TTP 3: Leading discussions about goals of care
- This EPA focuses on the application of communication skills to lead discussions with patients and families about progression of illness and evolution of the goals of care.
- This includes patients with complex medical issues and/or life-limiting conditions for whom decisions regarding goals of care may impact plans for management.
- This EPA includes the legal and ethical aspects of these discussions and decisions.
- It may also include providing referral to resources to support ongoing patient care and/or bereavement resources for the family.
- This EPA may be observed in simulation.
Direct observation by supervisor
Use form 1. Form collects information on:
- Setting: clinical; simulation
Collect 2 observations of achievement.
- No more than 1 in simulation
- ME 2.1 Identify patients with life-limiting conditions, including those for whom the burden of disease-modifying treatment or investigations may be greater than the clinical benefit.
- ME 2.3 Recognize and respond to signs that it is time to transition care away from a diseasemodifying approach
- COM 3.1 Share information about diagnosis and prognosis clearly and compassionately
- COM 3.1 Use strategies to verify the understanding of the patient and/or family
- COM 2.1 Gather information about the patient’s beliefs, values, preferences, context and expectations with regard to their care
- ME 2.3 Address the impact of the medical condition on the patient’s future quality of life
- ME 2.3 Establish goals of care in collaboration with the patient and/or family
- COM 1.5 Recognize when strong emotions (e.g., fear, anger, anxiety, sorrow) are impacting an interaction and respond appropriately
- ME 2.4 Develop a plan to optimize symptom management in support of the patient’s goals of care
- ME 2.4 Develop management plans that accurately reflect the patient and/or family’s goals of care
- COM 5.1 Document the clinical encounter to accurately reflect the discussion and decisions