Table 1.

Primary Focus and Prototypical Clinician Questions Illustrating 3 Approaches to Care

AspectPatient-Centered CareNarrative MedicineGoal-Oriented Care
Primary focusHealth problems (symptoms, diseases)Person’s life story (actual, imagined)Desired outcomes (goals, priorities)
Meaningful life goals
Prevention of premature deathNow that you have turned 45, you should begin to get screened for colon cancer. Knowing how you feel about invasive procedures, would yearly stool tests be preferable to colonoscopy?What would you like to see and do before you die?
What do you think you could do to increase the chance that you will live long enough to experience those things?
What do you think you are most likely to die from?
Have you thought about how to keep that from happening?
Good current quality of lifeWhat level of pain are you experiencing?
What troubles you most about it?
What have you done to try to handle it?
How much is the medicine I gave you helping?
How has the pain affected your marriage?
How has the pain affected the life you had imagined for yourself?
How would your life be different now had you not developed this painful condition?
What adjustments have you had to make?
What do you want to be able to do that you can’t do now?
Why are those activities important to you?
How much has the pain interfered?
What options have you considered?
Growth and development (physiologic, psychological, and spiritual)Can you tell me about your childhood?
How far did you go in school?
What jobs have you held?
Tell me about your marriage and other important relationships.
What challenges have you faced?
What would you like for me to know about you?
How would you say your life has gone to this point?
What does the future look like?
What challenges have you faced and what challenges do you anticipate?
What challenges are you facing?
How have you coped with similar challenges in the past?
What opportunities do they present for you?
How can I help?
Good deathHave you thought about your end-of-life wishes?
Have you completed advance directive documents?
Have you discussed them with your family?
How long do you expect to live?
How would you like to spend your final days?
What steps have you taken to try to help things turn out that way?
What conditions in life would be worse for you than death?
What have you done to make sure that when you die, you have a good death as you define it?