Optional discussion worksheet
Care preferences and medical decisions
Discuss information wishes, supporters, representatives, CPR and other treatment separately, and record where verified medical or legal documents are kept.
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1. What matters to the patient?
This worksheet records a conversation. It is not a DNAR order, an advance medical directive, a consent form, or permission to limit treatment. The treating team must assess and document the clinical plan and follow the applicable legal process.
Date / who is recording this / who the patient wants present
What gives life meaning; priorities, comfort, independence and personal concerns
How much information the patient wants, in what language and with what communication support
Who the patient wants information shared with; any limits they want discussed
Questions about the illness, uncertainty and what might happen next
2. Supporters, next of kin and existing documents
A next of kin or emergency contact is not automatically a person with blanket authority to consent. A patient who has decision-making capacity makes their own decisions. Ask the team to verify any representative’s authority and the applicable process.
Chosen contact or next of kin / relationship / contact; patient’s permission to involve them
Chosen supporter for discussions / contact / practical role; not an authority appointment
Any documented representative: name/contact, authority and document scope/location; team to verify
Existing advance medical directive: present / none / unsure; latest copy/date/location, whom it names, updates or revocation
Questions for the hospital or legal adviser; who will verify current legal requirements
3. CPR and a formal DNAR plan are a separate discussion
CPR is attempted when the heart or breathing stops. DNAR means not attempting CPR; it does not mean no treatment, no comfort care or automatic refusal of ICU, antibiotics, oxygen or other care. The clinician must discuss what is appropriate for the individual.
CPR conversation status
Questions about what CPR could realistically achieve and its burdens for this patient
Patient’s wishes to discuss with the treating team; not an instruction to stop treatment
If a separate clinician-documented DNAR plan exists: location, date, responsible clinician
Who will verify and explain that plan; when it should be reviewed
4. Discuss escalation, review and where care may be provided
Discuss each treatment on its own merits, including potentially reversible problems. Formal withholding or withdrawal of life-sustaining treatment has separate Indian safeguards; a tick or signature on this sheet cannot authorise it. If someone is acutely unwell, seek assessment rather than relying on an unverified worksheet.
Questions or wishes to discuss: hospital transfer, ICU, ventilation, dialysis or other escalation
Would a time-limited treatment trial be appropriate? Ask about goal, review and next steps
Preferred place of care and backup if needs cannot safely be met there
Verified clinical-plan location, responsible clinician and contact; copies held where
Review triggers: patient changes their mind, illness changes, transfer or document concerns
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These are discussion prompts, not prescriptions, emergency instructions or formal medical or legal documents. Use the current verified plan from your care team.
Read with this tool
- Preparing together for the last weeks and days of life
- When cancer returns or treatment stops working: a guide for patients and families
Sources and further reading
These prompts accompany the source-checked guides linked above. Their Sources and further reading sections contain the original references.