Critical medical decisions are often made without patients and families fully understanding the medical facts and without the medical team fully appreciating a patient’s goals and values. Shared decision making can address this gap leading to prognostic concordance. Prognostic Concordance is essential in allowing patients to make decisions based on their values. This concordance allows them to make decisions based on a reasonable prognostic expectation that is agreed upon by the patient and the clinician. Communication is also central to the clinician-patient relationship. There are different communication challenges at all phases of the cancer trajectory.  These discussions are typically emotionally charged and overwhelming and require practitioners to develop trust with the patient, identify and respond to patients’ emotions, and sort out when their own emotions interfere with effective communication. 

Most clinicians do not receive detailed and specific training on how to communicate effectively with patients, nor the complexities between advance directives and POLST forms. It is imperative that clinicians are given proper training, and the necessary tools to identify the need for and encourage the use of an advanced directive and POLST forms, as well as become aware of the resources that are available at City of Hope to them regarding advanced directive accessibility. A proper training on how utilizing the SPIKES protocol to deliver news, is also beneficial and necessary as such methods will result in better patient outcomes when serious illness conversations are had. 


City of Hope physicians.


This course is comprised of two parts. Participants are only eligible to receive CME Credits upon the completion of the full course.

Part 1 - Goal Concordant Care and Advance Care Planning 

  • A 1-hour training addressing the difference between Advance Directives (AD) and Physician Orders for Life Sustaining Treatments (POLST) forms and how to enter an ambulatory DNR order with the appropriate billing codes.

Part 2 - Goal Concordant Care and Difficult Conversations 

  • A 2-hour training addressing the importance of shared decision making throughout the disease trajectory and learn skills and techniques in how to have serious conversations.  


Full Course (completion of Part 1 & 2) must be completed by September 30, 2024

The following is required for Full Course completion:

  • Completion of Part 1 (Online Module), which is required in order to participate in Part 2.
  • Completion of Part 2 (Live Session).
  • Completion of Full Course Evaluation, which will be available upon completing Part 2.

Physicians Seeking to Obtain ABIM MOC Points:

Physicians who wish to claim ABIM MOC points for this activity must comply with the instructions noted above to obtain AMA PRA Category 1 Credit as well as the following:

  • Complete and successfully pass the ABIM MOC Activity Self-Assessment (Part II).
    • Minimum passing score of 67% will be required.
    • Participants will only have ONE opportunity to pass the Activity Self-Assessment (Part II).


  • Review goal concordant care conversations and case scenarios.
  • Incorporate advance care planning and advance directives.
  • Apply POLST forms and Ambulator DNR. 
  • Utilize ACP billing codes.
  • Identify some key strategies in how to effectively communicate with shared decision making.
  • Discuss case scenarios presented and integrate SPIKES protocol for each scenario.  
  • Apply the SPIKES protocol in delivering difficult news.
  • Discuss possible barriers and biases which may impact patient care (i.e., race, ethnicity, language, gender identity/orientation, age, socioeconomic status, attitudes, feelings, or other characteristics).


ACCREDITATION STATEMENT: City of Hope is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

CREDIT DESIGNATION: City of Hope designates this Other activity (composed of On Demand material and Live Webinar) for a maximum of 3.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

The following credit type(s) are being offered for this course:

•  AMA PRA Category 1 Credit™  3.0

The following may apply AMA PRA Category 1 Credit™ for license renewal:

Registered Nurses: Nurses may report up to 3.0 credit hours toward the continuing education requirements for license renewal by their state Board of Registered Nurses (BRN). AMA PRA Category 1 Credit™ may be noted on the license renewal application in lieu of a BRN provider number.

Physician Assistants: The National Commission on Certification of Physicians Assistants states that AMA PRA Category 1 Credit™ accredited courses are acceptable for CME requirements for recertification.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 3.0 Medical Knowledge MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit. 


FACULTY: The following faculty have indicated no relevant financial relationships. 

Heather Bitar, DO Assistant Clinical Professor, Division of Supportive Medicine, Department of Supportive Care Medicine; City of Hope

Sorin Buga, MD, FACP, FAAHPM Clinical Professor; Program Director, Hospice and Palliative Medicine Fellowship; City of Hope

Christine Jun, MD Assistant Clinical Professor of Medicine, Division of Supportive Medicine, Department of Supportive Care Medicine; City of Hope

Navneet Kaur, MD Assistant Clinical Professor, Department of Supportive Care Medicine, City of Hope

Eric D. Mecusker, DO Assistant Clinical Professor, Department of Supportive Care Medicine; Core Faculty, Hospice and Palliative Care Medicine Fellowship; City of Hope


A unique Attendance Code will be provided upon completion of Part 2. The attendance code must be submitted to the Department of Continuing Medical Education (CME) to record you completion of the Full Course. 

If you do not have an account in the City of Hope CME System and/or are not familiar with the Attendance Code text-in method, please take a moment now to complete the following steps:

  1. Create account here!
  2. Save the City of Hope CME Text-in number in your cell phone contacts
    • City of Hope CME Attendance Text-in number is: (626) 314 - 7448