Which situations require discussing resuscitation status with the patient or surrogate?

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Timing of discussions about resuscitation status is the focus. Resuscitation preferences aren’t fixed; they should be explored early to honor patient values and then revisited as the illness evolves. It’s important to have this conversation at the onset of admission so the care plan reflects the patient’s wishes from the start. Revisit the discussion when prognosis changes—new information or a shift in clinical trajectory can alter what is realistic or desired. Also, whenever there is a shift in goals of care (for example moving from curative to comfort-focused aims), resuscitation preferences should be reviewed and documented to match the new plan. This approach keeps decisions aligned with current reality and patient or surrogate values. Waiting only until discharge misses opportunities for informed choice, discussing only at admission misses changes in prognosis, and discussing only when goals shift misses the need to establish preferences upfront and adjust as conditions evolve.