TTP 3

TTP 3: Leading discussions about goals of care

Key Features

  • 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.

Assessment plan

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

CanMEDS milestones

  1. 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.
  2. ME 2.3 Recognize and respond to signs that it is time to transition care away from a diseasemodifying approach
  3. COM 3.1 Share information about diagnosis and prognosis clearly and compassionately
  4. COM 3.1 Use strategies to verify the understanding of the patient and/or family
  5. COM 2.1 Gather information about the patient’s beliefs, values, preferences, context and expectations with regard to their care
  6. ME 2.3 Address the impact of the medical condition on the patient’s future quality of life
  7. ME 2.3 Establish goals of care in collaboration with the patient and/or family
  8. COM 1.5 Recognize when strong emotions (e.g., fear, anger, anxiety, sorrow) are impacting an interaction and respond appropriately
  9. ME 2.4 Develop a plan to optimize symptom management in support of the patient’s goals of care
  10. ME 2.4 Develop management plans that accurately reflect the patient and/or family’s goals of care
  11. COM 5.1 Document the clinical encounter to accurately reflect the discussion and decisions
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