Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Honoring Patients’ and Families’ Goals of Care


When supporting critically ill or dying patients, keep their care goals at the forefront of conversations and planning.

“I don’t know why everyone keeps asking. I’ll never be able to say it’s time to stop.”


“You’ve already told us the chances are low. Please, we brought them here because we need to know we did everything possible.”


These are just two things you may hear from your patient and/or the family of someone who is critically ill or dying.


Meanwhile, you and your medical team might be thinking, “We’re doing everything we can and still the patient is getting worse. We need to talk about this again.”


When there are different ideas about the goals of care, take a step back and ask yourself the following questions:


1. What are the patient’s and family’s goals of care?


2. What are the medical team’s goals?


3. Where do those goals overlap? Where do the goals differ? How can we move forward from here?


If there’s another meeting scheduled with the patient and family to revisit the care plan when they’ve already made their wishes clear, consider the following:


1. Respect that they’ve shared their wishes and acknowledge those wishes. Try to keep your own feelings out of the discussion. They are the one grappling with loss.


2. If possible, give the discussion a rest for one meeting. Instead, give an update on how the patient’s doing and revisit the care plan next time.


3. If patients and families still want to do everything that’s possible and someone is offering more interventions, honor their wishes.



This piece expresses the views solely of the author. It does not represent the views of any organization, including Johns Hopkins Medicine.