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]
Optional Readings:
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]