{"id":952,"date":"2024-04-10T09:17:31","date_gmt":"2024-04-10T13:17:31","guid":{"rendered":"https:\/\/pressbooks.library.torontomu.ca\/npltc\/?post_type=chapter&#038;p=952"},"modified":"2024-04-10T09:21:01","modified_gmt":"2024-04-10T13:21:01","slug":"2-2-8","status":"publish","type":"chapter","link":"https:\/\/pressbooks.library.torontomu.ca\/npltc\/chapter\/2-2-8\/","title":{"raw":"2.2.8 Goals of Care","rendered":"2.2.8 Goals of Care"},"content":{"raw":"Goals of Care (GOC) discussions are important in the context of serious, life-limiting illnesses. The focus of GOC discussions is to:\r\n<ul>\r\n \t<li>Ensure that individuals and\/or their SDMs have a strong understanding of the nature of their illness<\/li>\r\n \t<li>Ensure that healthcare providers understand the patient\u2019s values and care goals<\/li>\r\n \t<li>Align care with patient\u2019s values, needs, and priorities[footnote]Hospice Palliative Care Ontario, n.d.[\/footnote][footnote]Ontario Palliative Care Network, n.d.-b[\/footnote][footnote]LeBlanc &amp; Tulsky, 2023[\/footnote][footnote]Dunlay &amp; Strand, 2016[\/footnote]<\/li>\r\n<\/ul>\r\nGoals of Care:\r\n<ul>\r\n \t<li>Curing the disease<\/li>\r\n \t<li>Prolonging and preserving life<\/li>\r\n \t<li>Relieving suffering<\/li>\r\n \t<li>Optimizing quality of life<\/li>\r\n \t<li>Maintaining control<\/li>\r\n \t<li>Achieving a peaceful and dignified death<\/li>\r\n \t<li>Providing support for family and loved ones<\/li>\r\n \t<li>Decisions that can result from GOC discussions:<\/li>\r\n \t<li>Resuscitation\/DNR orders<\/li>\r\n \t<li>Starting, continuing or stopping chemotherapy<\/li>\r\n \t<li>Location of care<\/li>\r\n \t<li>Initiating or discontinuing dialysis<\/li>\r\n \t<li>Limits to treatment[footnote]Ontario Palliative Care Network, n.d.-a[\/footnote][footnote]Health Quality Ontario, n.d.[\/footnote]<\/li>\r\n<\/ul>\r\nSteps to GOC Discussions:\r\n<ul>\r\n \t<li>Explore illness understanding<\/li>\r\n \t<li>Inform<\/li>\r\n \t<li>Elicit values and define goals<\/li>\r\n \t<li>Plan and document<\/li>\r\n \t<li>Document Goals of Care<\/li>\r\n \t<li>Revisit<\/li>\r\n<\/ul>\r\nOutcomes of GOC discussions:\r\n\r\nImproved understanding of illness, what to expect, care options, goals and values\r\n\r\nactively participate in making informed decisions about their care\r\n\r\nEnhanced patient-centered care\r\n<ul>\r\n \t<li>Improving GOC discussions:<\/li>\r\n \t<li>Practice good communication skills<\/li>\r\n \t<li>Use a conversation guide:\r\n<ol>\r\n \t<li>JUST ASK<\/li>\r\n \t<li>REMAP:\u00a0 Reframe, Expect emotion, Map out goals, Align with goals, Propose a plan<\/li>\r\n \t<li>SUPER:\u00a0 Setup, Understanding, Priorities, Explain, Review &amp; Recommend<\/li>\r\n<\/ol>\r\n<\/li>\r\n<\/ul>","rendered":"<p>Goals of Care (GOC) discussions are important in the context of serious, life-limiting illnesses. The focus of GOC discussions is to:<\/p>\n<ul>\n<li>Ensure that individuals and\/or their SDMs have a strong understanding of the nature of their illness<\/li>\n<li>Ensure that healthcare providers understand the patient\u2019s values and care goals<\/li>\n<li>Align care with patient\u2019s values, needs, and priorities<a class=\"footnote\" title=\"Hospice Palliative Care Ontario, n.d.\" id=\"return-footnote-952-1\" href=\"#footnote-952-1\" aria-label=\"Footnote 1\"><sup class=\"footnote\">[1]<\/sup><\/a><a class=\"footnote\" title=\"Ontario Palliative Care Network, n.d.-b\" id=\"return-footnote-952-2\" href=\"#footnote-952-2\" aria-label=\"Footnote 2\"><sup class=\"footnote\">[2]<\/sup><\/a><a class=\"footnote\" title=\"LeBlanc &amp; Tulsky, 2023\" id=\"return-footnote-952-3\" href=\"#footnote-952-3\" aria-label=\"Footnote 3\"><sup class=\"footnote\">[3]<\/sup><\/a><a class=\"footnote\" title=\"Dunlay &amp; Strand, 2016\" id=\"return-footnote-952-4\" href=\"#footnote-952-4\" aria-label=\"Footnote 4\"><sup class=\"footnote\">[4]<\/sup><\/a><\/li>\n<\/ul>\n<p>Goals of Care:<\/p>\n<ul>\n<li>Curing the disease<\/li>\n<li>Prolonging and preserving life<\/li>\n<li>Relieving suffering<\/li>\n<li>Optimizing quality of life<\/li>\n<li>Maintaining control<\/li>\n<li>Achieving a peaceful and dignified death<\/li>\n<li>Providing support for family and loved ones<\/li>\n<li>Decisions that can result from GOC discussions:<\/li>\n<li>Resuscitation\/DNR orders<\/li>\n<li>Starting, continuing or stopping chemotherapy<\/li>\n<li>Location of care<\/li>\n<li>Initiating or discontinuing dialysis<\/li>\n<li>Limits to treatment<a class=\"footnote\" title=\"Ontario Palliative Care Network, n.d.-a\" id=\"return-footnote-952-5\" href=\"#footnote-952-5\" aria-label=\"Footnote 5\"><sup class=\"footnote\">[5]<\/sup><\/a><a class=\"footnote\" title=\"Health Quality Ontario, n.d.\" id=\"return-footnote-952-6\" href=\"#footnote-952-6\" aria-label=\"Footnote 6\"><sup class=\"footnote\">[6]<\/sup><\/a><\/li>\n<\/ul>\n<p>Steps to GOC Discussions:<\/p>\n<ul>\n<li>Explore illness understanding<\/li>\n<li>Inform<\/li>\n<li>Elicit values and define goals<\/li>\n<li>Plan and document<\/li>\n<li>Document Goals of Care<\/li>\n<li>Revisit<\/li>\n<\/ul>\n<p>Outcomes of GOC discussions:<\/p>\n<p>Improved understanding of illness, what to expect, care options, goals and values<\/p>\n<p>actively participate in making informed decisions about their care<\/p>\n<p>Enhanced patient-centered care<\/p>\n<ul>\n<li>Improving GOC discussions:<\/li>\n<li>Practice good communication skills<\/li>\n<li>Use a conversation guide:\n<ol>\n<li>JUST ASK<\/li>\n<li>REMAP:\u00a0 Reframe, Expect emotion, Map out goals, Align with goals, Propose a plan<\/li>\n<li>SUPER:\u00a0 Setup, Understanding, Priorities, Explain, Review &amp; Recommend<\/li>\n<\/ol>\n<\/li>\n<\/ul>\n<hr class=\"before-footnotes clear\" \/><div class=\"footnotes\"><ol><li id=\"footnote-952-1\">Hospice Palliative Care Ontario, n.d. <a href=\"#return-footnote-952-1\" class=\"return-footnote\" aria-label=\"Return to footnote 1\">&crarr;<\/a><\/li><li id=\"footnote-952-2\">Ontario Palliative Care Network, n.d.-b <a href=\"#return-footnote-952-2\" class=\"return-footnote\" aria-label=\"Return to footnote 2\">&crarr;<\/a><\/li><li id=\"footnote-952-3\">LeBlanc &amp; Tulsky, 2023 <a href=\"#return-footnote-952-3\" class=\"return-footnote\" aria-label=\"Return to footnote 3\">&crarr;<\/a><\/li><li id=\"footnote-952-4\">Dunlay &amp; Strand, 2016 <a href=\"#return-footnote-952-4\" class=\"return-footnote\" aria-label=\"Return to footnote 4\">&crarr;<\/a><\/li><li id=\"footnote-952-5\">Ontario Palliative Care Network, n.d.-a <a href=\"#return-footnote-952-5\" class=\"return-footnote\" aria-label=\"Return to footnote 5\">&crarr;<\/a><\/li><li id=\"footnote-952-6\">Health Quality Ontario, n.d. <a href=\"#return-footnote-952-6\" class=\"return-footnote\" aria-label=\"Return to footnote 6\">&crarr;<\/a><\/li><\/ol><\/div>","protected":false},"author":517,"menu_order":23,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-952","chapter","type-chapter","status-publish","hentry"],"part":3,"_links":{"self":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/npltc\/wp-json\/pressbooks\/v2\/chapters\/952","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/npltc\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/npltc\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/npltc\/wp-json\/wp\/v2\/users\/517"}],"version-history":[{"count":3,"href":"https:\/\/pressbooks.library.torontomu.ca\/npltc\/wp-json\/pressbooks\/v2\/chapters\/952\/revisions"}],"predecessor-version":[{"id":955,"href":"https:\/\/pressbooks.library.torontomu.ca\/npltc\/wp-json\/pressbooks\/v2\/chapters\/952\/revisions\/955"}],"part":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/npltc\/wp-json\/pressbooks\/v2\/parts\/3"}],"metadata":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/npltc\/wp-json\/pressbooks\/v2\/chapters\/952\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/npltc\/wp-json\/wp\/v2\/media?parent=952"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/npltc\/wp-json\/pressbooks\/v2\/chapter-type?post=952"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/npltc\/wp-json\/wp\/v2\/contributor?post=952"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/npltc\/wp-json\/wp\/v2\/license?post=952"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}