Medical Indications

• Diagnosis
• Prognosis
• Intervention
  • Risks
  • Benefits
• Symptom Management
• Nutrition

Patient Preferences

• Informed/involved in decisions
• Plan of care
• Expectations
• Resuscitation

Quality of Life

• Activities
• Relationships
• Emotional
• Spiritual

Contextual Issues

• Home
• Caregiver/Family
• Cultural
• Spiritual
• Financial
• Legal
• Social

• “how much information do you want to know about your prognosis”?
  • Wants to know: determine specific information wanted
    • how to present:
      • provide information with “ballpark” exception
      • “it is impossible to predict for any individual with certainty but the average person with your………..”
  • Does not want to know:
    • assess why, acknowledge emotion, provide enough for decisions or establish proxy
  • Ambivalent or afraid:
    • acknowledge, explore concerns, provide options for presenting