The audit findings indicate a potential gap in the consistent application of evidence-based palliative care principles within a multidisciplinary team. This scenario is professionally challenging because it requires balancing established clinical guidelines with individual patient needs and team dynamics, all while ensuring adherence to regulatory standards for patient care and documentation. Careful judgment is required to identify the most effective and compliant course of action. The best approach involves a comprehensive review of the patient’s current care plan, cross-referencing it with the latest evidence-based guidelines for managing their specific chronic condition and acute exacerbations. This review should be conducted collaboratively with the multidisciplinary team, focusing on identifying any deviations from best practices and exploring the rationale behind current interventions. The goal is to ensure that all treatment decisions are supported by robust scientific evidence and are tailored to the patient’s goals of care, while also documenting these discussions and decisions meticulously. This aligns with the ethical imperative to provide high-quality, patient-centered care and the regulatory requirement for accurate and thorough medical record-keeping, ensuring accountability and continuity of care. An incorrect approach would be to dismiss the audit findings without further investigation, assuming the current care is adequate. This fails to acknowledge the importance of continuous quality improvement and evidence-based practice, potentially leading to suboptimal patient outcomes and regulatory non-compliance. Another incorrect approach is to unilaterally alter the care plan based on a single piece of new research without team consensus or consideration of the patient’s specific context. This undermines the multidisciplinary nature of palliative care, can lead to fragmented care, and may not be ethically or regulatorily sound if patient consent or team agreement is not obtained. Finally, focusing solely on the patient’s immediate comfort without systematically evaluating the underlying chronic condition and potential for evidence-based interventions would be an incomplete approach, neglecting the comprehensive nature of palliative care. Professionals should approach such situations by first acknowledging the audit findings as an opportunity for learning and improvement. They should then engage in a structured, evidence-based review process, involving the entire care team and prioritizing patient-centered decision-making. This involves critically appraising the evidence, discussing its applicability to the individual patient, and documenting the rationale for all care decisions.

Scenario Analysis: This scenario is professionally challenging because it requires a nuanced understanding of the eligibility criteria for a specialized licensure examination. Misinterpreting these criteria can lead to significant professional setbacks for the applicant, including wasted time, financial loss, and potential reputational damage. It also places a burden on the examination board to ensure fair and consistent application of its rules. Careful judgment is required to distinguish between genuine eligibility and situations where an applicant may be attempting to circumvent established requirements. Correct Approach Analysis: The best professional approach involves a thorough and direct review of the applicant’s submitted documentation against the explicit purpose and eligibility requirements of the Applied Pacific Rim Palliative and Supportive Care Medicine Licensure Examination. This means verifying that the applicant possesses the foundational medical qualifications and the specific, documented experience in palliative and supportive care that the examination is designed to assess. The purpose of the examination is to ensure practitioners meet a defined standard of competence in this specialized field, and eligibility is predicated on demonstrating this through verifiable credentials and experience. Adhering strictly to these established criteria ensures the integrity of the licensure process and upholds the standards of the profession. Incorrect Approaches Analysis: One incorrect approach involves assuming that a broad medical license automatically confers eligibility for a specialized palliative care examination. While a general medical license is a prerequisite, it does not inherently demonstrate the specific knowledge and skills in palliative and supportive care that the examination aims to evaluate. This approach fails to recognize the specialized nature of the licensure and the distinct experience required. Another incorrect approach is to interpret “equivalent experience” too broadly, without clear guidelines or a defined equivalency framework. If the examination board has specific criteria for what constitutes acceptable palliative care experience, deviating from these without a formal process for assessing equivalence is a failure. This can lead to inconsistent application of standards and potentially allow individuals who do not meet the intended level of expertise to be deemed eligible. A further incorrect approach is to prioritize the applicant’s stated intent or perceived need for licensure over the established eligibility criteria. While an applicant’s motivation is important, the examination board’s primary responsibility is to uphold the standards set for licensure. Eligibility is determined by meeting objective requirements, not by the applicant’s personal circumstances or aspirations. Professional Reasoning: Professionals faced with such situations should adopt a systematic decision-making process. First, clearly identify the specific purpose and stated eligibility requirements of the examination. Second, meticulously compare the applicant’s submitted evidence against each of these requirements. Third, if ambiguity exists regarding equivalency or interpretation, consult the official examination guidelines or seek clarification from the relevant regulatory body. Fourth, maintain objectivity and fairness, ensuring that all applicants are assessed against the same established standards. The focus should always be on verifiable evidence and adherence to the regulatory framework governing the licensure examination.

Scenario Analysis: This scenario is professionally challenging because it requires balancing the patient’s immediate comfort and dignity with the pragmatic realities of resource allocation and the need for sustainable care models. The physician must navigate complex ethical considerations, including patient autonomy, beneficence, non-maleficence, and justice, within the context of a healthcare system that may have limitations. The pressure to provide optimal care while acknowledging resource constraints necessitates careful, evidence-based decision-making. Correct Approach Analysis: The best approach involves a comprehensive assessment of the patient’s palliative care needs, including their goals of care, symptom burden, and psychosocial support requirements. This assessment should then inform a discussion with the patient and their family about available evidence-based palliative care interventions, considering both their effectiveness and their cost-effectiveness. The focus is on maximizing quality of life and symptom relief within the most appropriate and sustainable care setting, which may involve a combination of home-based care, hospice services, and specialist palliative care consultations. This approach aligns with the ethical principles of beneficence (acting in the patient’s best interest) and justice (fair allocation of resources), while respecting patient autonomy through shared decision-making. It prioritizes individualized care plans that are both clinically appropriate and economically viable, reflecting a commitment to providing high-quality palliative care efficiently. Incorrect Approaches Analysis: One incorrect approach would be to immediately recommend the most resource-intensive option without a thorough assessment of the patient’s specific needs and preferences, or without exploring less costly but equally effective alternatives. This fails the principle of justice by potentially over-utilizing resources that could be allocated elsewhere, and may not align with the patient’s goals of care if they prefer a less intrusive setting. Another incorrect approach would be to prioritize cost savings above all else, leading to the provision of suboptimal or insufficient palliative care. This would violate the principle of beneficence, as it would fail to adequately address the patient’s suffering and potentially lead to a diminished quality of life. It also neglects the ethical imperative to provide compassionate and effective care to those nearing the end of life. A third incorrect approach would be to defer all decision-making to the family without adequately involving the patient in discussions about their own care, or without providing them with the necessary information to make informed choices. This undermines patient autonomy and can lead to care plans that do not reflect the patient’s true wishes or best interests. Professional Reasoning: Professionals should employ a structured decision-making process that begins with a thorough patient assessment, including their values and goals. This should be followed by an exploration of all clinically appropriate treatment options, considering their efficacy, patient preferences, and resource implications. Open and honest communication with the patient and their family is paramount, fostering shared decision-making. Finally, professionals must advocate for the patient’s needs while remaining mindful of the broader healthcare system’s resource constraints, seeking solutions that are both ethically sound and practically sustainable.

Scenario Analysis: This scenario is professionally challenging due to the potential for misinterpreting imaging findings in a complex palliative care patient. The patient’s advanced disease, comorbidities, and potential for atypical presentations necessitate a systematic and evidence-based approach to diagnostic reasoning and imaging selection. Failure to do so can lead to delayed or incorrect diagnoses, inappropriate treatment, and unnecessary patient distress or resource utilization. The ethical imperative is to provide the most accurate and least burdensome diagnostic pathway. Correct Approach Analysis: The best professional practice involves a multi-modal approach that integrates clinical assessment with judicious imaging selection and interpretation. This begins with a thorough clinical evaluation to formulate a differential diagnosis. Based on this, the most appropriate initial imaging modality should be chosen, prioritizing those that offer the best diagnostic yield for the suspected pathology while minimizing radiation exposure and patient discomfort. For suspected pulmonary emboli in a palliative patient with contraindications to contrast, a ventilation-perfusion scan is often the most appropriate initial step, followed by CT pulmonary angiography if the V/Q scan is indeterminate and the patient can tolerate contrast. Interpretation must be performed by a radiologist experienced in interpreting imaging in the context of palliative care, considering the patient’s overall prognosis and goals of care. This approach aligns with principles of patient-centered care, beneficence, and non-maleficence, ensuring that diagnostic interventions are both effective and appropriate for the patient’s stage of illness. Incorrect Approaches Analysis: Choosing a CT pulmonary angiography as the initial investigation without first considering the patient’s renal function and potential contraindications to contrast dye is ethically problematic. This approach risks nephrotoxicity from contrast agents, which is particularly concerning in a palliative patient where the potential benefit may not outweigh the risk of iatrogenic harm. It also bypasses a potentially less invasive and equally informative initial diagnostic step. Ordering a chest X-ray as the sole imaging modality for suspected pulmonary embolism is insufficient. While a chest X-ray can rule out some alternative diagnoses, it has very low sensitivity for detecting pulmonary emboli. This approach fails to adequately investigate the primary concern, potentially leading to a missed diagnosis and delayed appropriate management, which is a failure of beneficence. Proceeding directly to a pulmonary MRI without a clear indication or consideration of its limitations in this acute setting is also inappropriate. Pulmonary MRI is not the first-line investigation for suspected pulmonary embolism and can be time-consuming and technically challenging, potentially causing significant discomfort to a palliative patient. This represents a failure to select the most appropriate and efficient diagnostic tool. Professional Reasoning: Professionals should employ a systematic diagnostic reasoning process that begins with a comprehensive clinical assessment. This involves gathering a detailed history, performing a physical examination, and reviewing relevant laboratory data. Based on this information, a prioritized differential diagnosis should be established. Imaging selection should then be guided by the differential diagnosis, considering the diagnostic accuracy, invasiveness, cost, and patient-specific factors (e.g., comorbidities, allergies, patient preference, goals of care). Interpretation of imaging should be integrated with the clinical context, and findings should be communicated clearly to the patient and the interdisciplinary team to guide further management decisions. This iterative process ensures that diagnostic efforts are aligned with the patient’s overall care plan and maximize the likelihood of a beneficial outcome.

Scenario Analysis: This scenario is professionally challenging because it involves a physician seeking to understand the implications of a failed examination on their future practice and the process for re-examination. Navigating the specific policies of the Applied Pacific Rim Palliative and Supportive Care Medicine Licensure Examination board, particularly concerning blueprint weighting, scoring, and retake policies, requires careful attention to detail and adherence to established procedures. Misinterpreting these policies can lead to unnecessary delays, additional financial burdens, and potential career setbacks. Correct Approach Analysis: The best professional approach is to proactively seek clarification directly from the examination board regarding the specific blueprint weighting, scoring, and retake policies. This involves reviewing the official examination handbook, website, or contacting the board’s administrative office for precise details on how the examination is scored, the weighting of different content areas, and the exact conditions and procedures for retaking the examination. This direct engagement ensures accurate understanding and allows for informed decision-making about the next steps. This approach is correct because it relies on the authoritative source of information, minimizing the risk of misinterpretation and ensuring compliance with the examination’s governing body. Incorrect Approaches Analysis: One incorrect approach is to rely solely on anecdotal information from colleagues or online forums about retake policies. This is professionally unacceptable because such information may be outdated, inaccurate, or specific to different examination versions or jurisdictions, leading to significant misunderstandings and potentially non-compliance with the actual board requirements. Another incorrect approach is to assume that retake policies are standardized across all medical licensure examinations and apply general knowledge without verifying the specific rules of the Applied Pacific Rim Palliative and Supportive Care Medicine Licensure Examination. This is a failure to recognize the unique regulatory framework governing this particular examination and can lead to incorrect assumptions about eligibility, required preparation, and the retake process. A third incorrect approach is to delay seeking clarification, hoping that the examination board will proactively communicate any relevant policy changes or individual outcomes. This passive stance is professionally detrimental as it places the onus on the physician to be informed and proactive, and delays can impact their ability to plan their career progression effectively. Professional Reasoning: Professionals facing such situations should adopt a proactive and evidence-based approach. This involves identifying the authoritative source of information (in this case, the examination board), thoroughly reviewing all provided documentation, and seeking direct clarification when ambiguity exists. A structured decision-making process would involve: 1) Identifying the specific information needed (blueprint weighting, scoring, retake policies). 2) Locating the official source of this information. 3) Carefully reviewing the information, noting any areas of uncertainty. 4) Contacting the examination board directly for clarification on any unclear points. 5) Using the confirmed information to make informed decisions about future study and examination attempts.

Scenario Analysis: This scenario is professionally challenging because it requires the candidate to balance the immediate need for comprehensive preparation with the practical constraints of time and available resources. The pressure to pass a specialized licensure exam, particularly in a field like palliative and supportive care medicine which demands a broad and deep understanding, can lead to anxiety and potentially inefficient study habits. Effective resource management and strategic timeline planning are crucial for success, preventing burnout and ensuring mastery of the subject matter. Correct Approach Analysis: The best approach involves a structured, multi-faceted preparation strategy that begins well in advance of the examination date. This includes identifying key learning domains outlined in the official examination blueprint, prioritizing areas of weakness through self-assessment or practice questions, and allocating dedicated study blocks for each domain. Utilizing a variety of reputable resources, such as peer-reviewed literature, established textbooks, professional society guidelines (e.g., relevant Pacific Rim palliative care associations), and accredited online courses, is essential. A realistic timeline should incorporate regular review sessions, mock examinations under timed conditions, and sufficient rest. This systematic and evidence-based method ensures comprehensive coverage, reinforces learning, and builds confidence, aligning with the professional obligation to maintain competence and provide high-quality patient care. Incorrect Approaches Analysis: Focusing solely on memorizing facts from a single, potentially outdated, review book without understanding underlying principles or clinical application is an ineffective strategy. This approach neglects the need for critical thinking and application of knowledge, which are central to palliative care. It also fails to address the breadth of the examination content and may lead to a superficial understanding. Relying exclusively on last-minute cramming, particularly in the week leading up to the exam, is highly detrimental. This method does not allow for adequate knowledge consolidation or skill development. It increases the risk of information overload, anxiety, and poor performance due to fatigue and stress, failing to meet the professional standard of diligent preparation. Engaging only with informal study groups without consulting official examination guidelines or authoritative resources can lead to misinformation or an unbalanced focus on specific topics. While peer learning can be beneficial, it should supplement, not replace, a structured and evidence-based preparation plan. This approach risks neglecting critical areas or focusing on less relevant material. Professional Reasoning: Professionals preparing for specialized licensure examinations should adopt a strategic and evidence-based approach. This involves understanding the examination’s scope and format, conducting a thorough self-assessment of knowledge gaps, and developing a personalized study plan that incorporates diverse, high-quality resources. Regular practice and self-evaluation are key to identifying areas needing further attention. A balanced timeline that includes sufficient time for learning, review, and rest is crucial for optimal performance and long-term retention of knowledge, ultimately benefiting patient care.

Scenario Analysis: This scenario presents a professional challenge due to the inherent complexity of integrating foundational biomedical sciences with clinical decision-making in palliative care. The patient’s declining renal function, coupled with the need for effective pain management, requires a nuanced understanding of drug pharmacokinetics and pharmacodynamics, particularly concerning renally excreted opioids. Misjudging the interplay between these factors can lead to suboptimal pain control, increased risk of adverse drug events, and a compromised quality of life for the patient, directly impacting the core principles of palliative care. Careful judgment is required to balance efficacy with safety in a vulnerable patient population. Correct Approach Analysis: The best professional practice involves a comprehensive assessment of the patient’s current renal function, specifically their estimated glomerular filtration rate (eGFR), and a thorough review of the pharmacokinetic and pharmacodynamic profiles of potential opioid analgesics. This approach prioritizes selecting an opioid with a favorable safety profile in renal impairment, such as hydromorphone or fentanyl, and initiating it at a reduced dose with careful titration based on clinical response and monitoring for adverse effects. This aligns with the ethical imperative to provide safe and effective care, minimizing harm while maximizing benefit, and adheres to best practice guidelines for pain management in patients with compromised renal function, which emphasize dose adjustment and vigilant monitoring. Incorrect Approaches Analysis: Choosing an opioid known to accumulate in renal impairment, like morphine, without significant dose reduction and increased monitoring, poses a substantial risk of opioid-induced neurotoxicity, including confusion, delirium, and myoclonus, due to the accumulation of active metabolites. This fails to uphold the principle of “do no harm” and disregards established clinical guidelines for managing pain in renal insufficiency. Administering a standard dose of any opioid analgesic without considering the patient’s renal status or adjusting for it, and relying solely on patient-reported pain scores for titration, is a dangerous oversight. This approach ignores the fundamental biomedical principle that impaired renal function alters drug clearance, leading to unpredictable drug levels and an increased likelihood of toxicity, even if the patient subjectively reports adequate pain relief. Prescribing a strong opioid analgesic at a standard dose and assuming the patient will communicate any adverse effects, without proactive monitoring for signs of opioid toxicity or dose-related side effects, demonstrates a lack of due diligence. This passive approach fails to account for the altered physiological state of the patient and the potential for delayed or unrecognized adverse drug reactions, which is particularly critical in palliative care where patient communication can be affected by their condition. Professional Reasoning: Professionals should employ a systematic approach that begins with a thorough patient assessment, including relevant biomedical parameters like renal function. This should be followed by an evidence-based selection of therapeutic agents, considering their pharmacokinetic and pharmacodynamic properties in the context of the patient’s specific physiological status. A proactive monitoring plan, tailored to the chosen medication and the patient’s condition, is essential for ensuring safety and efficacy. This framework emphasizes a patient-centered, risk-aware, and ethically grounded approach to clinical decision-making.

Scenario Analysis: This scenario presents a significant professional and ethical challenge due to the inherent conflict between a patient’s expressed wishes, their perceived capacity, and the clinician’s duty of care. The patient, Mr. Chen, is experiencing a decline in his cognitive function, which raises questions about his ability to fully comprehend the implications of his treatment choices. Simultaneously, his strong desire to remain at home, even with palliative care, clashes with the potential for his condition to worsen and require more intensive support than can be provided in that setting. Navigating this requires a delicate balance of respecting patient autonomy, ensuring patient safety, and upholding professional ethical obligations within the framework of health systems science, which emphasizes patient-centered care and resource allocation. Correct Approach Analysis: The best professional approach involves a comprehensive assessment of Mr. Chen’s capacity to make informed decisions, coupled with open and empathetic communication with him and his family. This approach prioritizes understanding Mr. Chen’s values, goals, and fears regarding his care. It necessitates a multi-disciplinary team discussion to explore all available palliative care options, including home-based services, respite care, and potential future transitions to inpatient hospice if his needs exceed home capabilities. The process should involve documenting all discussions, assessments, and decisions meticulously. This aligns with ethical principles of autonomy (respecting his wishes as much as possible), beneficence (acting in his best interest, which includes ensuring his safety and comfort), and non-maleficence (avoiding harm, which could arise from inadequate care at home). It also reflects health systems science by considering the coordinated delivery of care across different settings and the appropriate utilization of resources to meet patient needs effectively. Incorrect Approaches Analysis: One incorrect approach would be to immediately override Mr. Chen’s wishes and insist on admission to a hospice facility solely based on the clinician’s assessment of his declining condition and the perceived risks of home care. This fails to adequately respect patient autonomy and may cause significant distress to Mr. Chen and his family, potentially eroding trust. It bypasses the crucial step of thoroughly assessing his capacity and exploring all possible home-based support mechanisms. Another incorrect approach would be to solely defer to the family’s concerns about Mr. Chen’s home care without engaging Mr. Chen directly in a meaningful capacity assessment and discussion about his preferences. While family input is vital, the primary ethical obligation is to the patient, and their wishes, if they have capacity, must be given significant weight. This approach risks paternalism and may not reflect Mr. Chen’s true desires for his end-of-life care. A third incorrect approach would be to provide palliative care at home without a clear plan for escalation or reassessment of Mr. Chen’s needs and capacity. This could lead to a crisis situation where his care needs are suddenly unmet, potentially resulting in unnecessary suffering or an emergency hospital admission, which is often contrary to the goals of palliative care. It neglects the dynamic nature of his illness and the importance of proactive care planning. Professional Reasoning: Professionals should employ a structured decision-making process that begins with a thorough assessment of the patient’s clinical status and their capacity to make informed decisions. This should be followed by open, honest, and empathetic communication with the patient and their family, exploring their values, goals, and concerns. A multi-disciplinary team approach is crucial to identify all available care options and resources. Documentation of all assessments, discussions, and decisions is paramount. This systematic approach ensures that patient autonomy is respected, beneficence and non-maleficence are upheld, and care is delivered in a coordinated and effective manner, aligning with the principles of health systems science.

This scenario presents a professional challenge due to the inherent conflict between a patient’s expressed wishes and the perceived best interests of their family, complicated by cultural considerations and the potential for differing interpretations of palliative care goals. Navigating this requires a delicate balance of patient autonomy, family involvement, and adherence to professional ethical guidelines. Careful judgment is essential to ensure patient-centered care while respecting familial dynamics. The best approach involves facilitating a structured, open, and documented discussion with the patient and their family, ideally with the involvement of a multidisciplinary team, to clarify goals of care and address concerns. This approach prioritizes the patient’s right to self-determination, as enshrined in principles of informed consent and patient autonomy, which are fundamental to palliative care practice. It also acknowledges the importance of family in the care process, seeking to integrate their perspectives within the patient’s expressed wishes. Documenting these discussions ensures transparency and accountability, aligning with professional standards for record-keeping and communication. An approach that solely prioritizes the family’s expressed wishes over the patient’s clear directives would be ethically unacceptable. This fails to uphold the principle of patient autonomy, potentially leading to a violation of the patient’s right to make decisions about their own body and care, even if those decisions differ from what the family desires. It also risks undermining the trust between the patient and the healthcare team. Another unacceptable approach would be to proceed with interventions or withhold care based on assumptions about the patient’s wishes without direct, clear communication and confirmation from the patient themselves. This bypasses the essential process of shared decision-making and can lead to care that is misaligned with the patient’s values and preferences, potentially causing distress and a loss of dignity. Furthermore, unilaterally imposing a course of action without attempting to understand and address the underlying cultural or familial concerns would be professionally inadequate. While the patient’s wishes are paramount, ignoring the context in which those wishes are expressed can lead to misunderstandings and an incomplete picture of the patient’s overall needs and support system. The professional reasoning process in such situations should involve: 1) Actively listening to and validating all expressed concerns from the patient and family. 2) Clearly identifying the patient’s stated goals of care and ensuring they are understood. 3) Exploring the family’s concerns and the reasons behind them, seeking to understand their perspective. 4) Facilitating open communication and negotiation between the patient and family, with the healthcare team acting as mediators and educators. 5) Involving relevant members of the multidisciplinary team (e.g., social workers, chaplains, ethics consultants) to provide comprehensive support and guidance. 6) Documenting all discussions, decisions, and rationale thoroughly.

Scenario Analysis: This scenario is professionally challenging because it involves a patient with a complex, life-limiting illness and a family deeply invested in their care, but with differing perspectives on treatment goals. The physician must navigate these differing views while respecting the patient’s autonomy and ensuring their best interests are met, all within the framework of shared decision-making principles. This requires not only clinical expertise but also strong communication, empathy, and an understanding of ethical and potentially relevant regulatory guidelines concerning patient rights and informed consent. Correct Approach Analysis: The best approach involves facilitating a structured conversation where the patient’s values, preferences, and goals are explicitly explored and documented. This includes actively listening to the patient’s concerns and desires, as well as acknowledging and addressing the family’s input without allowing it to override the patient’s expressed wishes. The physician should then clearly articulate the medical situation, prognosis, and available treatment options, including palliative care and symptom management, in a way that is understandable to the patient and family. This collaborative process ensures that the treatment plan aligns with the patient’s wishes and values, upholding the principle of patient autonomy and informed consent, which are cornerstones of ethical medical practice. This approach directly supports the patient’s right to self-determination in their healthcare decisions. Incorrect Approaches Analysis: One incorrect approach involves prioritizing the family’s expressed wishes over the patient’s stated preferences, especially when the patient is capable of making their own decisions. This undermines patient autonomy and can lead to care that is not aligned with the patient’s values, potentially causing distress and a loss of trust. It fails to recognize the patient as the primary decision-maker. Another incorrect approach is to present a single treatment option as the only viable path forward without thoroughly exploring the patient’s goals or other potential alternatives, including non-curative but comfort-focused care. This can be perceived as paternalistic and does not allow for true shared decision-making, potentially leading to a treatment plan that the patient does not truly consent to or desire. A third incorrect approach is to avoid discussing the difficult realities of the prognosis or the potential benefits and burdens of different treatment paths, opting instead for a vague or overly optimistic outlook. This deprives the patient and family of the necessary information to make informed choices and can lead to unrealistic expectations, hindering effective palliative care planning. Professional Reasoning: Professionals should employ a framework that prioritizes patient-centered communication. This involves establishing rapport, actively listening to understand the patient’s and family’s perspectives, clearly explaining medical information and options, exploring values and goals, and collaboratively developing a care plan. Regular reassessment of the patient’s understanding and preferences is also crucial, especially in the context of progressive illness.