Suggest Goals
The task of thinking about and setting goals is new for most people. This may be the first time that anyone has asked them about their goals. They may need some suggestions and some time to consider them. Terms like “intubation”, “resuscitation”, or even “palliation” may be poorly understood and may not add much to the discussion.
For example, you may say:
- “People facing only weeks to live often aim for quality of life and noninvasive interventions only.”
- “People close to death often ask for care that secures comfort and does not aim to prolong life”
- “In the last stage of life you (or your husband) may choose to be at home with as much support as possible instead of in hospital where the emphasis is on interventions and treatment”
- Watch the videos below for an example.
Sometimes patients and families are not ready for these suggestions. It is still valuable to start the discussion. Goals change over time.
Other approaches to discussing goals with a patient are to ask about the importance of function or trade-offs. Examples include:
- “What abilities are so critical to you in your life that you can’t imaging living without them?”
- “If you become more unwell, how much are you willing to go through for the possibility of gaining more time?”
Discussion: Suggest Goals
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k
good discussion that gives clear details
family participation
having family participate is key
Good information
futility discussions are difficult and ventilation discussions can be particularly hard
aa
it’s unfair to not give the patient and family a realistic picture
Clear explanation about intubation, most family members may not know this process.
patient quality of life and dignity are very important.
Definitely. And the family’s definition of quality of life and dignity needs tone defined. Different cultures and religions see these matters in different lights.
ok
Well done.
Yes
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ok
concur
great strategies
agree
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Physician does excellent job explaining processes in a way that pt can understand
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ok
describing all ecompassing palliative care
good approach
ok
ok
ok
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clear, good info strightforward
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nice set goals
Good information.
Good to sent the goals
good information
good information
good information
Good education
ok
good discussion
great discussion
agreed
great actors
ok
good work
good
honest
avoids jargon. good
Clear, honest, straighforward
clear explanation
What do you do when the family can’t accept the decline of a loved one?
great
Very good and clear discussions.
good approach
I think it is very important for family to know that interventions like a ventilator aren’t going to cure these palliative patients. They are not going to come back to their former selves.
Very good use of BASIC language. Easy to understand.
Good approach-rule out unreasonable options
very clear
good discussion
honest communication
good discussion
Be honest and direct
agree
agree with above
good discussion
this is almost exactly how I have the conversation when people ask specifically about that, but I got the sense this woman may have wanted to know about other options (eg. medications to keep his breathing comfortable). I usually wouldn’t mention a ventilator if we had already talked about comfort as our focus (but of course, address it if the family brings it up)
Explains the options, but balances the interventions with the likely outcome of the husband’s condition.
good discussion
great
Clear discussion about the reality/severity of the situation – took the time to explain to his wife
teaching and putting time in makes a difference.
The healthcare provider discusses quality of life and the need to focus on making the patient comfortable, talking about using minimal invasive treatment for discussing equipment like ventilators and discussing issues of life support, so that the family member can think about what is in the best interest of her family member. Well done!
good approach. this will definitely help me in discussions with patients
Always important for them to understand what critical care really means
Good teaching.
rrrrr
including goals, explaining outcome/consequences good to know as a tool.
Good to explain reasonable goals and the outcomes/ consequences associated with interventions. ie. reality of ventilator
explaining clear goals is beneficial
clear objectives
clear explanation to the family and understandable
I thin this scenario is very helpful in allowing the POA,his spouse to understnad clearly what different alternaives would mean for her partner
Great
Honest conversation. Clear.
agreed
Facilitating family presence during rescussitation allows family to fully understand the choices they are making.
good examples
clear explanation to the family
Often the discussion itself is a treatment. The discussion can often release tension in the caregivers by providing a solution and hope to a complex problem that has not been previously addressed.
Someone had my thought, Oxygenation does not mean a machine, when nasal prongs are used. It provideds the minimal aid to the patient, and the family feels that there was a matter addressed by the doctor(What about his breathing?).
Hay que permitir que los familiares se expresen claramente y evacuar dudas para que puedan tomar decisiones
Hay que orientar a las familia
clear objetives
la honestidad en fundamental
hay que educar
Clear explanations of what is actually involved, including the potential adverse effects of them, are really helpful, especially since things like ventilation require sedation and may rob families of interactions with their loved one.
Clear goals!
ytred
It’s hard to do some of this when I have 36 patients to see in a 12 hour shift. A lot of us know what to say but simply are too pressed for time.
🙂
discharged
xx
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Discussing all that is involved is imperative, sometimes the family doesn’t understand what the options actually entail. A clear explanation is key.
Participating of family members in decision taking is important.
Discussing what interventions actually means, needles ventilation monitors etc is important. Many families may not understand what aggressive intervention entails and any benefit of intervention
The wife seemed a bit confused when the MD mentioned the ventilator. Perhaps a longer more thorough discussion of its implications are needed here.
I think he did well until he mentioned the ventilator, if she agreed on comfort measures intubating is not a comfort palliative measure. managing his dyspnea in palliation and providing comfort is important for her to understand
I agree. Discussing the advantages and disadvantages of ventilation is useful. It gives the family a clear picture of the outcomes. As well, most of the patients I have been involved with have been OK with nasal prongs or a mask. However, nasal prongs are more comfortable.
just simple nasal prongs satisfy the families as we are doing something but really nothing at the time. most families don’t want ventilators they are scary!and agree dont’ offer end of left comfort or dignity.
the discussion clearly outlines the futility of any aggressive intervention and defines comfort care
a clear explanation about the futility of intubation and ventilation is making it easier for the fmily member to understand and then participate in a goal setting