"Yes it's sad, but what should I do?" Moving from empathy to action in discussing goals of care.

The communication skills of noticing emotional cues and responding empathically are necessary but insufficient for some conversations about redefining goals of care. For some patients, an empathic response by a clinician is insufficient to move the conversation forward. We describe an expert approach that links empathy to action. In this approach, we outline (1) how affect provides a spotlight that illuminates what is important, (2) how empathy affords a way to connect with patients and families that engages deep values, (3) how clinicians can infer deep values through an associative process with patients, and (4) how clinicians can then design actions with patients and families and nurture their commitment to the actions.