What is the proper approach to discussing prognosis and goals of care with a patient?

• A. Honest, compassionate communication; assess patient values and preferences; involve family as appropriate; document.
• B. Withhold information to avoid distress to the patient.
• C. Focus solely on medical prognosis without discussing values.
• D. Delegate the discussion to a nurse.

Answer: (A)

Discussing prognosis and goals of care hinges on honest, compassionate communication that respects patient autonomy and uses shared decision making. This approach provides clear information about the illness and likely outcomes while also exploring what matters most to the patient—their values, hopes, fears, and acceptable trade-offs. By assessing these preferences, you can align medical options and the plan of care with what the patient values for quality of life. Involving family or trusted supporters when the patient desires can help with understanding and decision support, but the patient’s own preferences should drive the decisions. Documenting the discussion and agreed-upon goals ensures continuity of care and clarity for future decisions. Withholding information undermines autonomy and can increase distress, and focusing only on prognosis without considering values risks misalignment with what the patient truly wants. Delegating the discussion entirely to a nurse misses the physician’s responsibility to lead and ensure informed, values-based decisions.