Clarifying Patient Goals of Care
What You’ll Learn
Learn best practices for building trust, eliciting patient values, and having patient-centered conversations about goals of care.
- Explain how to create a foundation for discussions about future care.
- Review the five steps of the REMAP model for guiding conversations on care goals.
- Describe an approach to introducing hospice to patients and families or caregivers when appropriate.
What You’ll Earn
Only CAPC members who are logged in can earn the following free Continuing Education Credits:
- 1.00 AMA PRA Category 1 Credit(s)™
- Case Management: 1.00 CE
- Nursing: 1.00 CNE
- Social Work: 1.00 CE (NASW)
- Social Work: 1.00 CE (NYSED)
To take this course, log in. Or, check here to see if your organization is a member.
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Tools & Resources
A stepwise approach for all members of the health care team for clarifying patient goals of care.
Goals of care tips for care managers.
In this video, Kacey Boyle, RN, MSPC, leads us through an example of a goals of care conversation between a clinician and a patient.
This conversation script provides skills and techniques for conducting goals of care conversations with patients, regardless of the existing clinician-patient relationship.
In this video, Jonathan Fisher, MD, leads us through a mock conversation between a patient whose illness has progressed, and a clinician who explains the benefits of hospice care.
This communication script provides techniques for clinicians to foster meaningful conversations about hospice.
Order set that guides providers based on patients' advance care planning decisions.
One-page guides with actionable tips for conversations with patients with serious illness. Free to download, print and share with others.
This resource provides practical samples of empathic responses to use in conversations with patients and families, as well as template responses to challenging questions. Developed by VitalTalk.
List of course citations.
Course Faculty
Robert Arnold, MD. Distinguished Service Professor of Medicine; Medical Director, UPMC Palliative and Supportive Institute; Director, Institute for Doctor-Patient Communication; Co-Founder and Co-Chair, Board of Directors, VitalTalk
Anthony Back, MD. Co-Founder, VitalTalk; Co-Director, Center for Excellence in Palliative Care, University of Washington
Kacey Boyle, RN, MSPC, CHPN. Palliative Care Specialist, The University of Vermont Medical Center
Constance Dahlin, MSN, ANP-BC, ACHPN, FPCN, FAAN. Consultant, Center to Advance Palliative Care
Andrew E. Esch, MD, MBA. Senior Education Advisor, Center to Advance Palliative Care
Jonathan Fischer, MD. Palliative Medicine Specialist, Associate Consulting Professor, Department of Family Medicine and Community Health, Duke Health
Katie Grogan, DMH, MA. Associate Director, Clinical Education, Center to Advance Palliative Care
Kristin Martin, MS. Instructional Designer, Center to Advance Palliative Care
Peer Reviewers
Sherika Newman, DO. Associate Medical Director, CenterWell Primary Care Anywhere-Georgia*
Caroline Cruickshank, BSN, RN. George Washington University Hospital
Sophie Rotax, BSN, RN. George Washington University Hospital
Elizabeth Jurczak, LMSW. University of Connecticut School of Social Work
*indicates ABIM Peer Reviewer
Course Artists
Kriota Willberg, MFA-IA, LMT, CAPC Artist-in-Residence
Contact information: For answers to frequently asked questions about CAPC courses, read the Online Course FAQ. For technical questions about course activity, email [email protected]. For questions about continuing education credits, contact 201-957-0077.
Provided by the Icahn School of Medicine at Mount Sinai.
Course 1 of 5
Learn best practices for having patient-centered conversations about a serious illness diagnosis.
Course 2 of 5
Learn how to effectively discuss prognosis with patients and their caregivers.
Course 4 of 5
Learn to effectively lead meetings that help patients and caregivers become aligned around the patient’s goals.