26 2.2.8 Goals of Care

Goals of Care (GOC) discussions are important in the context of serious, life-limiting illnesses. The focus of GOC discussions is to:

• Ensure that individuals and/or their SDMs have a strong understanding of the nature of their illness
• Ensure that healthcare providers understand the patient’s values and care goals
• Align care with patient’s values, needs, and priorities^[1][2][3][4]

Goals of Care:

• Curing the disease
• Prolonging and preserving life
• Relieving suffering
• Optimizing quality of life
• Maintaining control
• Achieving a peaceful and dignified death
• Providing support for family and loved ones
• Decisions that can result from GOC discussions:
• Resuscitation/DNR orders
• Starting, continuing or stopping chemotherapy
• Location of care
• Initiating or discontinuing dialysis
• Limits to treatment^[5][6]

Steps to GOC Discussions:

• Explore illness understanding
• Inform
• Elicit values and define goals
• Plan and document
• Document Goals of Care
• Revisit

Outcomes of GOC discussions:

Improved understanding of illness, what to expect, care options, goals and values

actively participate in making informed decisions about their care

Enhanced patient-centered care

• Improving GOC discussions:
• Practice good communication skills
• Use a conversation guide:
  1. JUST ASK
  2. REMAP:  Reframe, Expect emotion, Map out goals, Align with goals, Propose a plan
  3. SUPER:  Setup, Understanding, Priorities, Explain, Review & Recommend