Goals of Care
Determining a patient’s goals of care is one of the most complex conversations that occurs in the Emergency Department. This is far more than “DNR or not” “intubate or not.” Taking the time to move beyond those simplistic formulations of care towards getting a good sense of what the patient and the family want leads to more satisfactory outcomes for everyone.
- No one goal is more valid than others
- Multiple goals can exist at the same time
- Goals can change over time or even rapidly
Goals may include one or more of the following:
- Treatment/cure of disease
- Prevention of further decline
- Treatment of symptoms
- Prolongation of life
- A dignified death
- A trial of aggressive intervention
- Return home
- Admission to hospital
A “goals of care” conversation needs to include a clear awareness of global trajectories and prognosis. It will help the patient, family, and care-giving team guide decisions and choices regarding care. Patients and families look to the Emergency physician for accurate and reliable information that is empathically communicated.
It can seem strange that it’s an Emergency physician, who knows the patient only briefly, who is having this conversation. However the patient’s presence in the ED almost always signals a turning point in their trajectory. It is an opportunity to move beyond “intubate or not” and make a real contribution to the patient’s well-being.
The following pages review the components of a goals of care discussion using videos to illustrate them.
Discussion: Goals of Care
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GOC at every point in care is important to establish
having a common goal that the patient, family, and physicians all agree on must be hard since each component might have different interests. Above all, the patient should have the final say. It gets even harder if the patient is not competent to make decisions.
Very important to get done
goals of care are important
a plan is necessary, but should have occurred prior to ED
agreed. a plan is always necessary
When doing homecare assessments I always addressed GOC and advanced care planning.
Importante conocer los objetivos de atención para un enfoque realista c y comunicación con la familia
goals must align
I’d also discuss the availability of treatment options.
goals must aligned with patients’ wishes and comfort
comfort verse DNR
important discussions to have
Good to know the goals
The statement that” the patient’s presence in the ED almost always signals a turning point in their trajectory” is very true and have to realised by treating EPs. Then realistic discussion can be made with the family and also admitting team.
Goals must agree with one another
important to acknowledge multiple goals
Clear concise language. Theirs.
cuidado y educación
El lan de cuidado es fundamental
establish clear goals
I agree with ” varga”
It is important to discuss with patients about their wishes/wills not only about death but goals of Rx during disease/sickness and terminal stages.
I have had living wills with patient’s goals of care outlined, however in cases of cancer and/or advanced dementia these wishes were challenged by their loved ones. Very interesting situation, in that the family would question how informed medically were their loved ones whey they made theses choices many years ago.
many HCPs are ‘parachuted’ in, to have this conversation, mostly d/t HCP not having the ‘dreaded’ conversation in a timely manner
I find that the living wills patient bring to the office often fall to the wayside when they present to the ER in crisis.
It is impotant to enquire about change in the goals.
agree with all of the above it will be very informative to know what the previous goals of care were as well