Goals-of-care conversations and advance care planning for children — formative SAQs

SAQ 1 — Structured goals-of-care meeting for an adolescent with cancer (10 marks)

A 15-year-old with relapsed leukaemia is admitted for the third time in two months. The team recognises there is no documented goals-of-care plan. The family is anxious and asks "what do we do if the treatment stops working?" ^[1]

Questions

1. Outline how you would structure the goals-of-care meeting using the Serious Illness Conversation Guide. (6 marks) ^[2]
2. Describe how you would capture this adolescent's own voice, and state one evidence-based benefit of doing so. (4 marks) ^{[3] [11]}

Model answer

Structure using the Serious Illness Conversation Guide (6). First prepare: review the chart, confirm the prognosis with the treating team, and identify who should be in the room and arrange a quiet space and an interpreter if needed. Set up: warn the family that a goals-of-care conversation is coming and ask permission to talk honestly. Assess: elicit what they already know, how much they want to know, and what matters most to them, before sharing prognosis. Share: give the prognosis in plain language, honestly and with compassion, and respond to emotion rather than rushing on. Align: connect what the family cares about to what the team can realistically offer and name the goals-of-care frame (curative, complex chronic, or comfort). Plan: agree the frame, record the treatments wanted and not wanted and the resuscitation status, and write the portable order. ^{[1] [2]}

Capturing the adolescent's voice and evidence (4). The 15-year-old is developmentally able to take part, so invite her directly and use an age-appropriate tool such as Voicing My CHOiCES or the family-centred (FACE) advance care planning structure so her preferences are recorded in her own words, not mediated only through her parents. The evidence-based benefit is that family-centred ACP for teens with cancer raises and sustains adolescent-family congruence on end-of-life treatment preferences and improves family positive caregiving appraisals — she is prepared, and her family is supported. ^{[3] [11]}