1. End of life (EOL) discussions are difficult to initiate in any setting, but especially in the Emergency Department. However, new or worsening illness can be a key moment to start conversations.

2. During discussions, be as honest and direct as possible while employing tools such as compassion, listening and silence.

3. When your patient is a child or adolescent, consider their developmental stage and understanding of death, realizing that often children with chronic illnesses have some delay in achieving developmental milestones.

4. Management of EOL symptoms differs from conventional management, so goals regarding a patient’s care should be thoroughly discussed and established prior to discontinuation and/or escalation of the patient’s medications.

5. Consult and utilize appropriate resources, including the palliative and hospice care team, for assistance with difficult conversations and applying appropriate guidelines for symptom management.