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Back to Module 7: Goals of Care Introduction to Goals of Care

A Brief Introduction
What are Goals of Care?
Objectives of this Module

A Brief Introduction

Every one of us has a very personal sense of who we are, what we like to do, what brings the greatest meaning and value to our lives, how much control we like to have in our lives, and the things we hope for. When we confront a significant illness and the possibility that we will die, we will make choices for our treatment and care based on our diagnosis and prognosis, the potential benefits and risks associated with various therapies, and our personal priorities.

Our patients and their families also have very personal hopes and goals for their lives. Before developing or negotiating any plan of care, a physician must clarify patient and family hopes and goals for care and current treatment priorities. Regular review of these goals and priorities will ensure that the patient, family, and health care team are striving for the same outcomes, and not missing expectations or providing unwanted therapies.

This module presents an approach for eliciting a patient’s goals for care (or parents’ goals when the patient is a child) and clarifying his or her treatment priorities. While it will focus on patients who are nearing the end of their lives, the process can be used at any time during a person’s illness.

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What are Goals of Care?

• Everyone has a personal sense of:

• Who we are
• What we like to do
• Control we like to have
• Goals for our lives
• Things we hope for

• Hope, goals, expectations change with illness

• Many possible goals for care--prevention, cure, prolongation of life, achieving a good death

• Multiple goals may apply simultaneously, no one goal is inherently more valid than another. For example, attempts to reverse illness or restore health care be pursued at the same time as efforts to relieve suffering and improve quality of life

• Specific clinical skills are needed for negotiating goals for care

• Physicians must be able to:

• Identify reasonable things to hope for according to the patient's culture and preferences
• Convey prognosis even with all its uncertainty
• Use appropriate language
• Set limits, if necessary
• Manage even when the patient lacks decision-making capacity

• Potential goals of care:

• Cure of disease
• Avoidance of premature death
• Maintenance or improvement in function
• Prolongation of life
• Relief of suffering
• Quality of life
• Staying in control
• A good death
• Support for families and loved ones

• A Clinical Care Example

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Objectives of this Module

• Understand the different goals for care and how they interrelate and change
• Understand how to use the 7-step protocol to negotiate goals of care
• Understand how to identify reasonable hope
• Be able to adjust care and communication according to culture
• Be able to communicate prognosis and its uncertainty
• Be able to use language effectively
• Be able to set limits on unreasonable goals
• Understand how to identify goals when patients lack capacity

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