Open the goals-of-care conversation with an adolescent with relapsed cancer and the family — OSCE

Candidate brief

You have eight minutes to open the goals-of-care and advance care planning conversation with a sixteen-year-old boy with relapsed osteosarcoma and his parents. The disease-directed options are limited and burdensome, and the family is frightened that palliative care means giving up. Use a structured, honest, empathic approach that reframes palliative care, explores the family's understanding and their hopes and worries, addresses the fear of abandonment, and builds a shared plan that integrates the disease-directed and the palliative care. [1][2]

Key teaching and communication objectives

Acknowledge and validate the family's fear before delivering the information, and allow silence. Explore what the family already understands about the illness and the prognosis, and what they hope for and what they worry about most. Reassure them that palliative care is not giving up, and explain in plain language that it is the active total care of the whole family that runs alongside the cancer treatment, focused on the comfort, the symptom control and the quality of life from this point onward. [1]

Address the fear of abandonment directly. Explain that choosing to integrate the palliative care does not stop the disease-directed treatment unless the family and the team decide together that the burden now outweighs the benefit, and that the team stays with the family through every option, every turning point and beyond. Reframe the hope honestly and hopefully, from the hope for the cure to the hope for the comfort, the presence and the meaningful time together. [2]

Address the symptom control and the place of care. Explain that the team will control the pain and the other symptoms aggressively, and that the family and the young person will be part of every decision, including the preferred place of the care between the home, the hospital and the hospice. Name the next steps honestly, a clear meeting with the palliative care team, a documented plan in the shared record, a named key worker, and a connection to the young person's and the family's support. Close with a shared plan and a clear next appointment, and acknowledge that this is a great deal to take in. [1][2]