When a patient requests aggressive measures that conflict with palliative goals, what is the recommended approach?

• A. Escalate to more aggressive treatment
• B. Use clear communication, revisit goals, discuss prognosis, and consider ethics consultation
• C. Withdraw care immediately
• D. Ignore patient wishes

Answer: (B)

When a patient’s wishes for aggressive treatment clash with palliative goals, the key is open, honest, patient-centered communication paired with a plan that reflects the patient's values and the likely outcomes of treatment. Start by discussing the patient’s understanding of their condition and prognosis in clear terms, then revisit the goals of care to see how they align with what matters most to the patient. This conversation should explore what benefits or burdens the proposed aggressive measures would bring, and consider whether the patient has decision-making capacity or a designated surrogate to help decide. Involve the interdisciplinary team to ensure all perspectives are considered, and if the conflict persists or raises ethical questions, an ethics consultation can help navigate tensions and guide a documented, consensus-based plan. This approach respects autonomy, supports informed choice, and keeps care aligned with the patient’s values while avoiding unilateral escalation or abandonment of patient wishes.