Discerning patient preferences for care at the end of life is a mainstay of caring for patients and families. Ideally, these discussions should happen early in a patient's care trajectory. In fact, we would be surprised by how eager many patients are to talk about their desires, their fears, and their goals as death draws near, and how eager many family members are to hear these preferences. When this doesn't happen, it is often necessary to have discussions with surrogates, as Chicca describes.

We need to assure families that even though certain nonbeneficial treatments may be discontinued, our care for their loved one will never end. Palliative care includes aggressive symptom management that continues through the lives of patients even when disease-focused therapies might not.

Margaret M. Mahon, PhD, CRNP, FAAN, FPCN

Bethesda, MD