Goals-of-Care & Serious Illness Conversations
Last updated: February 2026
The highest-stakes conversation in medicine — and the least practiced.
Goals-of-care conversations directly determine whether patients receive care aligned with their values. When these conversations happen well, ICU utilization drops, patient satisfaction rises, and malpractice exposure shrinks. When they don't happen — or happen poorly — patients receive care misaligned with their values, families are left in crisis, and hospitals absorb the downstream cost.
The opportunity
average savings per admission with palliative care consultation
Morrison et al., Archives of Internal Medicine, 2008
of sentinel events involved communication failures as root cause (1995-2005)
The Joint Commission
in malpractice costs linked to communication breakdowns over five years
CRICO Benchmarking Report, 2009-2013
What this means for your institution
in potential savings per palliative care consult
Average cost savings for patients who died in hospital (Morrison et al., 2008)
per year in avoided ICU costs for a 300-bed hospital
Based on 3,000 ICU admissions/year with 5% averted at ~$15,000 average ICU stay
Annals of ATS 2020; Morrison et al., Archives of Internal Medicine, 2008
Two hours of training for a career of difficult conversations.
The average resident receives fewer than two hours of formal training in serious illness conversations across their entire residency. Yet these conversations determine ICU utilization, goal-concordant care rates, and family satisfaction scores. The mismatch between stakes and preparation is staggering.
Only 29% of seriously ill patients report having had a goals-of-care conversation with their provider
Residents consistently rate goals-of-care as their lowest-confidence communication skill
The Serious Illness Conversation Guide (SICG) from Ariadne Labs improves outcomes — but requires practice to implement effectively
Simulation-based communication training improves performance on validated assessment tools within a single session
Why simulation works
Practice builds confidence. Confidence changes behavior. Better conversations change outcomes.
Practice the SICG Framework
Simulate conversations using the Serious Illness Conversation Guide structure — understanding, preferences, prognosis, and recommendations.
Reduce Avoidable ICU Days
Providers trained in goals-of-care conversations drive earlier hospice enrollment and fewer unwanted interventions.
Lower Malpractice Exposure
Better communication reduces the 40% of malpractice claims driven by communication failures.
Improve HCAHPS Scores
Structured communication training directly impacts patient experience metrics tied to hospital reimbursement.
The evidence
Associations Between End-of-Life Discussions, Patient Mental Health, Medical Care Near Death, and Caregiver Bereavement Adjustment
JAMA (2008)
Landmark study showing end-of-life discussions were associated with lower rates of ventilation (1.6% vs 11.0%), resuscitation (0.8% vs 6.7%), and ICU admission (4.1% vs 12.4%), plus earlier hospice enrollment.
reduction in ICU admissions when goals-of-care conversations occur
Wright et al., JAMA, 2008
direct cost savings per admission for discharged patients
Morrison et al., Archives of Internal Medicine, 2008
of patients had wishes followed after structured ACP intervention
Detering et al., BMJ, 2010
Frequently Asked Questions
What is a goals-of-care conversation?
A goals-of-care conversation is a structured clinical discussion in which a provider explores a seriously ill patient's values, understanding of their illness, and preferences for future treatment. These conversations help align medical care with what matters most to the patient — whether that's pursuing aggressive treatment, focusing on comfort, or something in between. The Serious Illness Conversation Guide (SICG) from Ariadne Labs is a widely used framework for conducting these conversations.
How do goals-of-care conversations reduce ICU costs?
Goals-of-care conversations reduce ICU costs by helping patients make informed decisions that often lead to less aggressive interventions. A landmark JAMA study (Wright et al., 2008) found that end-of-life discussions were associated with 3x lower ICU admission rates (4.1% vs 12.4%). Palliative care consultation — which centers on goals-of-care conversations — saves an average of $4,908 per admission for patients who die in hospital (Morrison et al., Archives of Internal Medicine, 2008).
What is the Serious Illness Conversation Guide?
The Serious Illness Conversation Guide (SICG) is a structured communication framework developed by Ariadne Labs to help clinicians have more effective conversations with seriously ill patients. The guide covers key domains: understanding the patient's awareness of their illness, exploring their values and priorities, sharing prognostic information, and making treatment recommendations. Studies show the SICG improves outcomes, but providers need practice to implement it effectively.
What percentage of malpractice claims involve communication failures?
Communication failures were the root cause of 66% of sentinel events reported to The Joint Commission (1995-2005), and drive approximately 40% of malpractice claims (Candello, 2025). CRICO found that communication breakdowns contributed to $1.7 billion in malpractice costs over a five-year period (2009-2013). Communication-related malpractice cases have 39% greater odds of closing with an indemnity payment compared to non-communication-related cases (Candello, 2025).
Related Insights
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End-of-Life Conversations: Practice Makes Progress
EOL conversations are low-frequency, high-stakes events. Traditional training models cant provide the practice clinicians need.
The ROI of Communication Training: By the Numbers
The business case for communication training is clear: reduced malpractice risk, improved HCAHPS scores, and better outcomes.