36 2.4.4 Goals of Care & Serious Illness Conversations

A serious illness is a condition that carries a high risk of death, substantially reduces quality of life and can impose a significant burden on the patient’s caregiver^[1]

Serious Illness conversation is not just:

• Code status conversations
• Conversations to share prognosis, life expectancy and recovery statistics
• Conversations to make immediate medical decisions

Challenges for Serious Illness conversations:

• Time pressures and complex life-saving procedures requiring acute decision-making
• Continuity of care^[2][3][4][5]

Benefits of early Serious Illness conversations:

• Increased goal-concordant care
• Increased patient and family satisfaction with care
• Better preparation for making treatment decisions, even in challenging and time-sensitive situations
• Improved patient quality of life
• Reduction in the use of non-beneficial, intensive treatments
• Cost savings by avoiding unnecessary treatments
• Enhanced healthcare provider-patient relationships

Clinician identified barriers to GOC discussions in LTC settings:

• Caregiver reactions and treatment understanding
• Lack of time for conversations
• Residents not having advance care planning
• Inadequate documentation of previous GoC conversations^{[6][7][8][9][10]}