Goals-of-care conversation OSCE — adolescent oncology and a child with no plan

Station objectives

1. Run a structured goals-of-care conversation using the Serious Illness Conversation Guide (set up, assess, share, align, plan). [1] [2]
2. Capture a developmentally able adolescent's voice with an age-appropriate tool. [3] [11]
3. Share honest prognosis with compassion and respond to emotion. [8]
4. Document and disseminate a usable advance care plan. [1] [12]

Candidate brief

You are the paediatric registrar in an oncology and complex-chronic service. You have 12 minutes for Station A and 12 minutes for Station B. Examiners score process, structure and synthesis over encyclopaedic recall. [1] [2]

Station A — Adolescent with relapsed leukaemia

Setup: A 15-year-old with relapsed leukaemia attends with her parents. She is developmentally able to take part. There is no documented goals-of-care plan. The family asks what would happen if treatment stops working. [3]

Expected actions:

• Set up: warn the family a conversation is coming and ask permission to talk honestly. [2]
• Assess: elicit what they know, how much they want to know, and what matters most to them and to the adolescent. [8]
• Share: give honest prognosis in plain language and respond to emotion. [8]
• Invite the adolescent directly and use Voicing My CHOiCES or family-centred ACP to capture her voice. [11]
• Align and plan: agree the goals-of-care frame, record treatments wanted and not wanted, resuscitation status, preferred place of care, and a review date. [1]

Station B — Technology-dependent child, parents who want everything

Setup: Parents of a technology-dependent 7-year-old with severe neurodisability and repeated admissions. There is no documented plan. They say they want everything done. [8]

Expected actions:

• Reassure the family that a comfort frame is not abandonment and separate comfort from giving up. [1] [8]
• Explore the child's values and baseline quality of life with the parents as expert surrogates. [9]
• Weigh the burden of each intervention against its realistic benefit and anchor the plan in best interests. [1]
• Agree and document the goals-of-care frame and convert it to a portable, disseminated order with a review date. [1] [12]

Marking anchors

Clear pass: five-step structure, honest prognostic disclosure with empathic response, adolescent's voice captured, goals-of-care frame named, documented and disseminated plan with a review date. [1] [3] Borderline: correct facts but no values elicitation, prognosis avoided, or an order recorded without an underlying goals-of-care frame. [8] Fail: avoids prognosis entirely, excludes the developmentally able adolescent, records an isolated resuscitation order with no conversation, or fails to disseminate the plan so it cannot be found at a crisis. [1] [12]

Debrief pearls

• Goals of care is the frame; the order flows from it, never the other way round. [9]
• Honest disclosure does not cause depression or remove hope — the evidence supports planning early. [8] [11]
• A plan that cannot be found at a crisis is no plan. [12]