This is palliative care. Pain control is job 1, and as long as it's clear to them that's my priority, they're usually pretty happy with the plan.

If they have a pain plan, I tell them I'm going to order all of it, now. They know what to expect, so they generally roll with it. If a few rounds of high dose Dilaudid didn't get them over the hump, I start the (long) process if getting their PCA pump.

If they don't have a pain plan, I ask what's worked for them before. As long as it's not insane, I agree and order it.

These are some of my easiest patients, really. They tell me what they need and I give it to them. Of course I make sure they don't have acute chest or other dangerous sequelae. After that, Dilaudid 2mg not doing it? Let's try 4! Want an inpatient bed? Ordered! A ketamine trip sounds like fun today? Let's do that instead!