Scenarios

1. 1

   Goals of care: planning with metastatic pancreatic cancer

   Explore values and desired information, explain treatment goals and palliative support, introduce future decision planning, and agree on practical follow-up.

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2. 2

   Goals of care: declining noninvasive breathing support

   Explore reasons for declining breathing support, assess decision-making ability, explain benefits and burdens, and agree on a supervised plan for symptom relief.

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3. 3

   Goals of care: family disagreement after a severe stroke

   Explain the stroke prognosis, explore the patient’s values, acknowledge family disagreement, and agree on a recommendation and supported next discussion.

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4. 4

   Goals of care: delirium and existing treatment limits

   Explain fluctuating decision-making ability and existing treatment limits, address distress, explore prior wishes, and agree on active care and reassessment.

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5. 5

   Goals of care: faith and hope after severe brain injury

   Explain the brain-injury prognosis, explore patient values and family beliefs, respond to distress, and agree on a supported next step.

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6. 6

   Goals of care: feeding decisions in advanced dementia

   Explore the patient’s prior values, explain feeding options and their limits, respond to family distress, and support a supervised decision.

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7. 7

   Goals of care: worsening illness despite intensive support

   Explain the team’s prognosis and treatment limits, explore the patient’s values, respond to family fears, and recommend a supported care plan.

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8. 8

   Serious news: explaining death by neurologic criteria

   Explain a completed determination of death in plain language, address apparent signs of life, respond to grief, and offer support.

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9. 9

   Goals of care: supporting a proxy through family disagreement

   Explore the patient’s values, acknowledge family disagreement without taking sides, explain the proxy role, and arrange a treating-team discussion.

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10. 10

    Consent discussion: request to hide medication

    Respond respectfully to a request for hidden medication, explain consent and capacity concerns, and arrange prompt clinician assessment and transparent care.

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11. 11

    Supportive conversation: spiritual distress after serious news

    Explore spiritual concerns without assumptions, acknowledge distress, respect the patient’s choices, and arrange optional support with permission and clear follow-up.

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12. 12

    Patient advocacy: a procedure plan and documented care goals

    Explain concerns about a proposed procedure using documented patient goals, request consultant review, and confirm responsibilities or further escalation.

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