COVID-19 Goals of Care: Conversation Script

This conversation map includes specific phrases to use when talking to patients who have COVID-19 about their goals of care. You can also download an editable version of this script. Developed by VitalTalk.

Clinician: Hello is this Ms. McNally? I’m Dr. Back from the COVID-19 response team.
Family: Hi.

Clinician: I understand your father has tested positive for COVID-19.
Family: Yes. I’m very worried. I feel guilty that he got it in a nursing home. I thought that place would be ok.

Clinician: Anyone would be worried. And there is no way you could have known this would happen.
Family: I suppose so.

Clinician: Is it ok if we talk about what COVID-19 means for your father?
Family: Please.

Clinician: May I first ask if you are the person who makes medical decisions for him.
Family: Yes. I’m his surrogate whatever you call it. I have the papers.

Clinician: Perfect. I like to make sure I’m talking to the right person.
Family: That’s me.

Clinician: I need to give you some background. Most people who get COVID-19 have a mild or moderate illness and don’t need the hospital. The people who most often get severe pneumonia with COVID are older and have existing medical problems, like your father.
Family: You know, I’ve heard that on the news but have been afraid to think about it.

Clinician: Well that’s a very normal reaction. COVID has put all of us in a tough situation.
Family: Yes. And I know that you are so busy.

Clinician: We are doing our best under the circumstances. So I hope your father has a mild case and can stay where he is. We can make sure he gets all the treatments he needs. However, if his COVID becomes severe, it will almost certainly take his life.
Family: I was afraid you would say that.

Clinician: It’s not what any family member wants to hear. Given that, if the worst-case scenario happened and he was going to die, do you think he would rather be in the hospital or be at home—I mean at his nursing home.
Family: Gosh. That’s a big decision.

Clinician: I can see that you want the best for him.
Family: Absolutely.

Clinician: Let me put it another way. If he didn’t have dementia and was as sharp as you or me. And he understood COVID-19 and what would happen if he got a severe case. If he were sitting here with us, what would he say?
Family: Oh he would say, enough already. I’ll stay here. But I don’t know.

Clinician: It sounds to me like if you put on his hat, and become him, he’d say "enough already." But if you put on your hat, you’d say, "I don’t know." Do I have that right?
Family: Yes. I’m not ready to lose him.

Clinician: Tell me more.
Family: He’s always been there for me and my kids. He’s the backbone of the family. He always believed in me.

Clinician: Would he believe in you now? To speak for him?
Family: When you put it like that, I know the answer. I just don’t like it.

Clinician: It’s not the kind of decision anyone wants to make. It does sound like you two may have talked about this?
Family: He told me when he was first diagnosed with dementia, back then he was just a little forgetful, nothing big. We were driving to the park to walk the dog. He turned to me and said, "Remember, when I can’t do this anymore, it’s time to let me go."

Clinician: Wow, thank you for telling me that.
Family: I had kind of forgotten about that. It's funny—I can see him saying it to me.

Clinician: Hmm. That kind of memory is a gift. Would it be ok to honor that?
Family: Now it’s clear to me. Let’s keep at him at his home.