INCLUSION  Patient  Age ≥60 Lack of decision-making capacity as determined by clinical examination by the attending physician or designee Clinical indication of at least 50% risk of death or ≥50% chance of new, severe long-term functional impairment (needs assistance with ≥ 2 ADLs), as judged by the patient's attending physician or designee  Surrogate  The primary surrogate is determined by the patient's advance directive or, if no directive exists, by following the hierarchy of surrogates codified in state law. Up to 3 additional surrogates  Clinician  1. Patient's primary attending (or their designee)  EXCLUSION  Patient  Lack of a surrogate decision maker Family not available for study Imminent death (within 24 hours); goals of care are already "comfort measures only"; decision to withdraw life support has already been made Currently participating in a competing research study that does not allow co-enrollment Incarcerated or on an involuntary hold Died prior to enrollment Discharged prior to enrollment Regained capacity prior to enrollment Physician declined patient's participation Physician and designee declined own participation Patient does not meet inclusion criteria within 5 days of ICU admission  Surrogate  Age <18 years Cannot read or understand English Cannot complete questionnaires due to physical or cognitive limitations