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Modules:

  • Introduction
  • 1. Advance Care Planning
  • 2. Communicating Bad News
  • 3. Whole Patient Assessment
  • 4. Pain Management
  • 5. Assisted Suicide Debate
  • 6. Anxiety, Delirium
  • 7. Goals of Care
  • 8. Sudden Illness
  • 9. Medical Futility
  • 10. Common Symptoms
  • 11. Withholding Treatment
  • 12. Last Hours of Living
  • 13. Cultural Issues
  • 14. Religion, Spirituality
  • 15. Legal Issues
  • 16. Social and Psychological
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    Back to Module 7: Goals of Care
    Goals of Care

    7-Step Protocol to Negotiate Goals of Care
    Identifying Goals to Hope For
    Cultural Considerations
    Communicating Prognosis
    Use of Language Setting Goals and Priorities for Treatment and Care
    Decision-Making Capacity

    Use of Language

    Language With Unintended Consequences

    • Well-intentioned physicians may say things that will have unintended consequences
    • What the listeners understand may be quite different from what the physician intended
    • Some examples of questions that can have unintended consequences include:
      • Do you want us to do everything possible?

      • Will you agree to discontinue care?

      • We’ll refrain from extraordinary measures?

      • It’s time we talk about pulling back?

      • I think we should stop aggressive therapy

      • I’m going to make it so he won’t suffer
    • The unintended message of these statements may easily be that the patient and family expect imminent abandonment and see only a stark choice between aggressive curative intent and giving up

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    Language to Describe Goals of Care

    • In order to prevent unintended consequences, it is useful to develop facility with language that reinforces the goals of appropriate medical care for someone with advanced progressive illness and a life-threatening prognosis
    • Some examples include:
      • I want to give the best care possible until the day your child dies

      • We will concentrate on improving the quality of your life

      • We want to help you live meaningfully in the time that you have

      • I’ll do everything I can to help you maintain your independence

      • I want to ensure that your father receives the kind of treatment he wants

      • Your child’s comfort and dignity will be my top priority

      • I will focus my efforts on treating your child’s symptoms

      • Let’s discuss what we can do to fulfill your wish to stay at home
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