Which element should be included in an end-of-life care plan?

• A. Only physician directives
• B. Decision-making proxies, goals of care, symptom management, and communication plan
• C. Hospital billing information
• D. Only the patient’s immediate preferences

Answer: (B)

End-of-life care planning is about ensuring that a patient’s values guide decisions even when they cannot speak for themselves. The most comprehensive approach includes decision-making proxies who can act if the patient can’t communicate, clear goals of care that express the desired level of intervention (comfort-focused versus more aggressive treatments), a plan for symptom management to control pain and distress, and a communication plan that documents who should be involved, who to contact, and how updates will be shared. When these elements are together, care aligns with the patient’s wishes across changing circumstances and settings, and families and clinicians stay coordinated.

Relying only on physician directives misses the patient’s values and surrogate input; hospital billing information is irrelevant to care decisions; and focusing solely on the patient’s immediate preferences may not address future decision-making needs or how to adapt the plan as conditions change.