61 2.7.4 Goals of Care Conversations in a Palliative Context

Goals of Care (GOC) conversations:

• Are different from ACP conversations
•  Should be resident centered and should be aligned with their previously expressed values and wishes
• GOC conversations help put previously expressed wishes (ACP discussions) into current clinical context leading to identification of specific medical decisions
• GOC conversation is usually initiated based on patient’s risk of mortality
  • Low risk of death
  • Intermediate risk of death
  • High risk for imminent death^[1][2]

ACP and GOC conversations can provoke strong emotional response from residents and/or care partners.  They may also present with subtle clues through body language suggestive of processing information they were not expecting. It is important to not provide false reassurance out of your own discomfort and align resident/care partner’s hope with the poor prognosis by using the following statement, “I wish things were different”.^[3]