EM Cases · End-of-life and goals of care
Goals-of-care family meeting — communication station
ACEM Fellowship OSCE on GOC framing, advance directives, and comfort-plan language without slow codes.
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Study tools
Target exams
ACEMFRCEMABEMFRCPCCCFPEMEBEEM
Prompt
An 82-year-old with metastatic cancer is peri-arrest. Advance care directive declines ICU/CPR. Daughter demands 'everything'. Lead a goals-of-care meeting aligning care with the patient's values.
Station brief
Format. Communication station, 11 minutes. Actor plays daughter; patient is too unwell to participate. You are the EM consultant.
[1]Candidate instructions. Acknowledge emotion, explain clinical trajectory, use substituted judgement from the patient's advance directive and known values, set a clear ceiling (comfort-focused; not for CPR/ICU), and outline symptom-control plan without framing as abandonment.
[1]References2ShowHide
- [1]Paladino J, et al. Evaluating an Intervention to Improve Communication Between Oncology Clinicians and Patients With Life-Limiting Cancer: A Cluster Randomized Clinical Trial of the Serious Illness Care Program. JAMA Oncol, 2019.PMID 30870556
- [2]Loffredo AJ, et al. United States Best Practice Guidelines for Primary Palliative Care in the Emergency Department. Ann Emerg Med, 2021.PMID 34353647