Module 2: Direct Comprehensive Primary Care in the LTC Setting

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]

  1. Jacobsen et al., 2022
  2. Harris et al., 2021
  3. Cameron & Laupacis, 2019
  4. Vancouver Coastal Health, n.d.
  5. Baxter et al., 2023
  6. Choosing Wisely Canada, n.d.
  7. Jacobsen et al., 2022
  8. Clarke et al., 2023
  9. Siu et al., 2020a
  10. Nova Scotia Health, 2023

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Nurse Practitioners Delivering Primary Care in the Long Term Care Setting Copyright © 2024 by Erin Ziegler, Carrie Heer and Adhiba Nilormi is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License, except where otherwise noted.

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