Clinicians must be able to identify persons who are at high risk for dying and who need to determine their goals of care, according to a review that provides structured guidance, specific advice, and practical tools for health care providers who need to address end-of-life care with patients.

John J. You, MD, MSc, of McMaster University in Hamilton, Ontario, Canada, and coauthors based their “conversation guide” on information gleaned from scientific evidence, systematic reviews, and expert opinions. The guide, presented in CMAJ, is organized around a framework that will help clinicians talk about end-of-life care with hospitalized patients.

As summarized in a statement from McMaster University, the information in the review can help clinicians:


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  • Identify patients at high risk for dying, such as persons with metastatic cancer or stage IV lymphoma
  • Communicate prognosis
  • Clarify patient values around the care plan
  • Involve substitute decision-makers in care planning, and
  • Properly document the patient’s wishes.

You and team explain that determining goals of care is a process, and clinicians should exercise judgment and flexibility in engaging patients and their family members in such discussions. Although some patients may be well prepared for such talks, others may require a phased approach, in which the topic is first introduced early in the hospital stay, with more detailed follow-up taking place later.