How to discuss goals of care with patients

Effective communication with patients and their caregivers continues to form the basis of a constructive clinician-patient relationship and is critical to provide patient-centered care. Engaging patients in meaningful, empathic communication not only fulfills an ethical imperative for our work as clinicians but also leads to increased patient satisfaction with their own care and improved clinical outcomes. While these same imperatives and benefits exist for discussing goals of care and end-of-life, communicating with patients about these topics can be particularly daunting. While clinicians receive extensive training on how to identify and treat illness, communication techniques, especially those centering around emotion-laden topics such as end-of-life care, receive short shrift medical education. Fortunately, communication techniques can be taught and learned through deliberate practice, and in this article, we seek to discuss a framework, drawn from published literature and our own experience, for approaching goals-of-care discussions in patients with cardiovascular disease.