Goal-Discordant Care — SCE Palliative Medicine MCQ

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ModerateCommunication & EthicsGoal-Discordant CareSCE Palliative Medicine

A palliative care consultant is asked to comment on a case where aggressive chemotherapy was continued until two weeks before death in a patient who had expressed a preference for comfort‑only care. This is an example of what quality concern?

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Correct answer: A — Goal‑discordant care — treatment that does not align with the patient’s expressed values and preferences, representing a failure of advance care planning and shared decision‑making

Explanation lettering: D = shown as A · E = shown as B · A = shown as C · C = shown as D · B = shown as E

Correct answer: D. The continuation of aggressive treatment in direct opposition to the patient's explicit preference for comfort‑only care exemplifies goal‑discordant care—a well‑recognised quality failure in palliative medicine, reflecting both inadequate advance care planning and lack of shared decision‑making. Option A describes what ideal practice should be, but was not delivered; B refers to the evidence base for treatment rather than its alignment with patient goals; C implies that aggressive treatment was appropriate—directly contradictory to the patient’s stated wishes; E is aspirational, whereas this scenario reflects a breach of that standard.

Reference: Barriers to High Quality End of Life Care in the Surgical Intensive Care Unit (2021) and Achieving Goal‑Concordant Care: A Conceptual Model (2018)