Goals-of-care conversations: a six-step framework
A printable scripter for the next fifteen-minute goals-of-care conversation. Six steps — open, listen, anchor to values, name the trade-offs, decide, document — written for the hospice or palliative team member who already has the next visit on the calendar.
Open with permission, not the goal.
Confirm the time, ask whether they want family on the call, and name what the visit is for. People answer better when they've been asked, not interrogated.
Let the first answer land before the second question.
Pause for ten seconds after each answer. Reflect what you heard in one sentence. Silence is a tool, not a failure.
Anchor decisions to what still matters today.
Ask what gives their days shape — independence, time at home, specific people, religious observance, avoiding a particular outcome. Write the answer in the patient's own phrasing.
Name the real price of each option.
Side effects, time in hospital, recovery chances, dependence on others. Use plain language: "more days but more time in the hospital" beats statistical framing.
Decisions can wait. Hesitation is data.
If a decision isn't ready, name the next conversation and the trigger that will force it. Document the patient's reasoning, not just the choice.
Capture the words, not just the checkbox.
Quoted phrases travel better than clinical summaries. Send a written summary to the patient within 48 hours.