Establishing Goals of Care in Serious and Complex Pediatric Illness

An increasing number of children are living for months and years with serious/complex illness that includes long-term prognostic uncertainty, intensive interactions with medical systems, functional limitations, and often chronic medical technologies that shape the child's and family's quality of life. These families often face many medical decision points and are supported by intentional and iterative discussions about goals of care. Threats to cohesive goals of care in complex pediatric illness include prognostic un-certainty, diffusion of medical responsibility, individual family context, and blended goals of care. This article offers strategies for addressing each of these chal-lenges-in all cases success involves recognizing how standard care approaches need adaptations to meet the needs of children with serious/complex illness.