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.
Accreditations and Disclosures
Physicians
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the providership of the Icahn School of Medicine at Mount Sinai. The Icahn School of Medicine at Mount Sinai is accredited by the ACCME to provide continuing medical education for physicians.
Icahn School of Medicine at Mount Sinai designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™ effective 3/04/2024 - 2/15/2026. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
CME Released: 3/04/2024; Valid for credit through 2/15/2026
Estimated Time of Completion for CME: 60 minutes
ABIM MOC Recognition Statement
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn 1.0 MOC credits in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC credits equivalent to the amount of CME credits claimed for this activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
Physician Assistants
The American Academy of Physician Assistants (AAPA) accepts credit from organizations accredited by the ACCME. Icahn School of Medicine at Mount Sinai designates this enduring material with 1.0 AMA PRA Category 1 Credit(s)™ as specified, which can be applied to the continuing education of Physician Assistants. Physician Assistants should claim only the credit commensurate with the extent of their participation in the activity.
Nurses (Registered Nurses, Advanced Practice Registered Nurses, Licensed Nurses)
This nursing continuing professional development activity was approved by Connecticut Nurses' Association, an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation.
CNE Released: 3/03/2024; Valid through 3/03/2026
Estimated Time of Completion for CNE: 60 minutes
Social Workers
This program is approved by the National Association of Social Workers (Approval # 886437049-1938) for 1.0 continuing education contact hours effective 2/07/2024 - 2/28/2025.
Center to Advance Palliative Care SW CPE #0257 is recognized by the New York State Education Department's Board for Social Work as an approved provider of continuing education for licensed social workers effective 3/03/2024 - 7/31/2027. This program has been approved for 1.0 continuing education contact hours.
Certified Case Managers
This program is approved by The Commission for Case Manager Certification (Approval # 240000428) to provide 1.0 continuing education credits to CCM® board certified case managers effective 3/03/2024 - 3/03/2025.
Verification of Attendance (VOA)
All users that are not eligible for continuing education will receive a Verification of Attendance certificate upon completion of the course.
Course Media Instructions
Software Requirements: CAPC’s online curriculum, tools, and technical assistance are designed to be fully compatible through multiple platforms: computer, smartphone (iOS or Android), or tablet running the following web browsers: Google Chrome, Mozilla Firefox, Safari, and Microsoft Edge.
Content: Each course is comprised of interactive learning components (articles, tools, or supporting materials), video, and audio. The learner will be expected to complete various interactive processes such as matching, simulated clinical decision-making, fill in the blanks, and highlighting content.
To successfully earn credit, participants must be logged in to their CAPC member account, complete the activity online, receive a minimum score of 80% on the post-test, and complete the course evaluation. A printable certificate of completion or a continuing award document specific to the discipline will be awarded.
Target Audience: Each program is developed for chaplains/spiritual counselors, nurses, physicians, physician assistants, social workers, case managers, palliative care program leaders, and healthcare leaders (hospital, health system, and community care).
Activity Description/Statement of Needs: CAPC’s online curriculum provides training in two critical areas. Technical assistance courses are designed to help palliative care program leaders address key challenges such as implementing palliative care in community health care settings. Clinical coursework provides fundamental training in pain and symptom management, communication, and other key skills needed to work with patients with serious illness.
Disclaimers: The opinions expressed in the courses are those of the authors and do not necessarily represent the views of the sponsor, the educational partner, or the supporter. Please review complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects before administering pharmacologic therapy to patients.
Activities do not contain information on commercial products/devices that are unlabeled for use or investigational uses of products not yet approved.
Faculty Disclosures and Financial Relationships: It is the policy of CAPC to ensure objectivity, balance, independence, transparency, and scientific rigor in all CE, CNE, and CME educational activities per the highest standards of ANCC and ACGME guidelines. For all courses, Faculty/Presenters/Authors/Content Reviewers/Planning Committee Members complete forms to disclose their relevant financial relationships. Any relevant financial relationships have been mitigated. No relevant financial relationships were identified for any individuals with the ability to control content of the activity.
Copyright Information: All rights reserved by the Center to Advance Palliative Care (CAPC). No materials may be used or reproduced in any manner whatsoever without written permission except in the case of brief quotations embodied in articles or reviews.
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.
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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.