Family Meeting/Goals of Care Note (Pediatric Oncology)

Date/Time of Meeting: [date; start time–end time]

Location/Modality: [inpatient unit / clinic / PICU; in-person / video / phone; bedside / conference room]

Clinician/Service: [author name and role; primary team / consulting service]

Reason for Meeting: [one-line purpose]

Participants & Decision-Making Authority

(List all attendees with name, role/relationship, and mode of participation. Include interdisciplinary team members and interpreter if used.)

• [Name] – [role/relationship] – [in person / video / phone]
• [Name] – [role/relationship] – [in person / video / phone]
• [Interpreter name/ID] – [language] – [in person / video / phone] (Only include if interpreter used)

Decision-making authority: [parent(s) / legal guardian / other] – [verified via chart / stated but unverified / verification pending]. [Custody or guardianship considerations if any.] (Do not infer legal status; document only what is stated or verified.)

Patient participation: [present / not present]; (If not present, state reason.) [capacity to participate: intact / limited / unable to assess]; [assent sought: yes / no / not developmentally appropriate]; [patient assented / dissented / expressed preferences: summary]. (If assent elicited, briefly document patient's expressed preferences.)

Clinical Context & Medical Discussion

[Patient age]; [oncologic diagnosis]; [current location]; [treatment status including current therapy line, response, and whether curative intent remains]; [decision urgency]. (Limit to 2–4 sentences; do not recapitulate full oncologic history.)

Medical update provided: (Summarize only decisive facts in plain language.)

• Current condition: [brief status]
• Disease status: [progression / relapse / stable / responding / mixed]
• Key findings: [concise bottom line of imaging, labs, or biopsy if directly relevant]
• Treatment options discussed: [options presented with major risks, benefits, and burdens in plain language]

Prognosis: [discussed / not discussed today]. (If discussed, document expected trajectory, uncertainty, and framing used. If not discussed, state brief rationale and whether future discussion is planned.)

(If no medical update was provided, state: "No medical update today; meeting focused on [focus of meeting].")

Values, Goals & What Matters Most

(Document only what was explicitly shared. Use brief direct quotes for high-salience statements. Note what remains unknown rather than inferring.)

• Patient-centered values: [what matters most to the child—comfort, function, being at home, school, siblings, activities, religious/cultural practices]
• Parent/caregiver perspective: [what they believe it means to care well for their child; include quotes as appropriate]
• Hopes: [hopes expressed]
• Worries: [worries expressed]
• Tradeoffs/unacceptable outcomes: [specific limits or thresholds stated] (Only include if explicitly stated.)
• Cultural, spiritual, or family decision-making preferences: [preferences and process]
• Information gaps: [what remains unclear or not yet discussed]

Decisions Made Today

(Document outcomes that can be operationalized immediately. If none, state "No decisions made today" with rationale.)

Goals of Care Summary: [one to two sentences capturing overarching goal]

Treatment Scope/Limitations: (Document only interventions actually discussed; avoid vague terms like "do everything" without specifying what that means.)

• [ICU transfer: desired / not desired / time-limited trial / not discussed]
• [Intubation/mechanical ventilation: desired / not desired / time-limited trial / not discussed]
• [CPR: desired / not desired / not discussed]
• [Vasoactive support: desired / not desired / time-limited trial / not discussed]
• [Dialysis: desired / not desired / not discussed]
• [Transfusions: desired / not desired / not discussed]
• [Disease-directed therapy: continue / pause / discontinue / clinical trial / not discussed]
• [Hospice: enroll / consider / declined / not discussed]

Code Status: Pre-meeting: [full code / DNR / DNI / partial limitations / unknown]. Post-meeting: [full code / DNR / DNI / partial limitations / unchanged]. (For partial limitations, specify included and excluded interventions.) Order [entered / updated / pending / not applicable]. (If not addressed, state: "Code status not discussed; remains [current status or unknown].")

Disagreement: [none / summary of differing views and resolution steps taken] (Document respectfully. Only include if disagreement occurred.)

Plan & Next Steps

(Document actionable tasks with ownership.)

• Follow-up meeting: [date/time or trigger for reconvening] – [responsible party]
• Consults/referrals: [palliative care / ethics / hospice / home health / DME / other] – [responsible party] – [status]
• Communication plan: [teams to update and method] – [responsible party]
• Symptom management changes: [changes and rationale] – [responsible party] (Only include if changes made.)
• Supportive services: [social work / chaplaincy / child life / sibling support / school coordination] – [responsible party] – [status]
• Orders/forms: [POLST/MOLST / advance directive / DNR order] – [status] – [responsible party]

(For sensitive domains—prognosis, code status, treatment limitations—explicitly document whether discussed or "not discussed today." Never infer goals, values, code status, or treatment preferences.)