SAFE-GOALS: a protocol for goals of care discussions in the intensive care unit

In critical care, there is often a lack of understanding regarding patient preferences toward end-of-life care. Goals of care discussions are poorly defined and inhibited by clinician apprehension, prognostic uncertainty, and discomfort from both sides. In the delivery of bad news, protocol-based discussions have proven beneficial, yet no such protocol exists for goals of care discussions in the intensive care unit (ICU). We therefore assembled a multidisciplinary team to define a specific protocol dedicated to leading goals of care discussions in the ICU setting.

S: set upA: acknowledgmentF: family understandingE: events of hospital courseG: get to know the patientO: optionsAL: active listening and discussionS: steps going forward.

This protocol provides a framework for leading goals of care conversations in the ICU. Specific training should be incorporated and better emphasized in the modern medical education.