Starting Goals of Care Conversations in Primary Care: Simple Starters That Work!

Goals of care conversations are essential, but they’re not always easy—especially in primary care. Time is short, emotions can run high, and patients aren’t always sure how to talk about what matters most to them. Still, these discussions are key to delivering care that’s aligned with a patient’s values, preferences, and life circumstances. The right conversation starter can make all the difference.

Here are practical ways primary care providers can begin goals of care conversations—early, respectfully, and effectively.

1. Use a “big picture” opener

Start by zooming out. A big-picture question helps patients step back from day-to-day symptoms and think about what they want long-term.

“As we look ahead, I want to make sure I understand what matters most to you. What are you hoping for in the next few months or year?”

This kind of question signals that you care about the person behind the patient. It creates space for them to talk about what’s most important—whether that’s staying independent, avoiding the hospital, or spending time with family.

2. Normalize the conversation

Sometimes patients feel caught off guard when care goals come up. You can reduce that tension by normalizing the conversation.

“I have this kind of conversation with all my patients as part of good care planning. It helps me understand what’s most important to you if your health ever changes.”

This helps patients see the conversation as a standard part of care—not a red flag.

3. Ask about past experiences

Patients often form their values based on what they’ve seen others go through. Asking about those experiences can lead to insights.

“Have you ever seen a friend or family member go through a serious illness? Did anything about that experience shape how you think about your own care?”

This lets patients express what they want—and don’t want—without needing to know medical jargon or specific treatments.

4. Check for understanding of illness and prognosis

Many patients have an incomplete or overly optimistic view of their condition. Gently checking their understanding can open the door to more realistic planning.

“What’s your sense of how your health is doing right now?”

“What have your other doctors told you about what to expect going forward?”

These questions don’t push an agenda—they help uncover gaps, assumptions, and misunderstandings.

5. Invite values-based decision making

Once there’s a shared understanding, shift the focus to values.

“If you were to get sicker, what would be most important to you?”

“Are there situations where you would or wouldn’t want certain treatments?”

These aren’t “yes/no” questions. They give patients room to express trade-offs they’re willing (or not willing) to make.

Final Thoughts

Goals of care conversations don’t need to be perfect or scripted. What matters is that they happen—early, often, and in a way, that’s grounded in trust. Primary care is uniquely positioned for these talks. With the right starter, you can make them part of the routine—and improve care for your patients in ways that matter most.

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