{"id":983,"date":"2024-04-10T09:57:53","date_gmt":"2024-04-10T13:57:53","guid":{"rendered":"https:\/\/pressbooks.library.torontomu.ca\/npltc\/?post_type=chapter&#038;p=983"},"modified":"2024-04-10T10:02:01","modified_gmt":"2024-04-10T14:02:01","slug":"2-4-4","status":"publish","type":"chapter","link":"https:\/\/pressbooks.library.torontomu.ca\/npltc\/chapter\/2-4-4\/","title":{"raw":"2.4.4 Goals of Care &amp; Serious Illness Conversations","rendered":"2.4.4 Goals of Care &amp; Serious Illness Conversations"},"content":{"raw":"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\u2019s caregiver[footnote]Jacobsen et al., 2022[\/footnote]\r\n\r\nSerious Illness conversation is not just:\r\n<ul>\r\n \t<li>Code status conversations<\/li>\r\n \t<li>Conversations to share prognosis, life expectancy and recovery statistics<\/li>\r\n \t<li>Conversations to make immediate medical decisions<\/li>\r\n<\/ul>\r\nChallenges for Serious Illness conversations:\r\n<ul>\r\n \t<li>Time pressures and complex life-saving procedures requiring acute decision-making<\/li>\r\n \t<li>Continuity of care[footnote]Harris et al., 2021[\/footnote][footnote]Cameron &amp; Laupacis, 2019[\/footnote][footnote]Vancouver Coastal Health, n.d.[\/footnote][footnote]Baxter et al., 2023[\/footnote]<\/li>\r\n<\/ul>\r\n<div class=\"textbox textbox--exercises\"><header class=\"textbox__header\">\r\n<p class=\"textbox__title\">Optional Readings:<\/p>\r\n\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n<ol>\r\n \t<li><a href=\"https:\/\/www.ariadnelabs.org\/resources\/downloads\/serious-illness-conversation-guide\/\">Serious Illness Conversation Guide<\/a><\/li>\r\n \t<li><a href=\"https:\/\/www.vitaltalk.org\/\">VitalTalk<\/a><\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\nBenefits of early Serious Illness conversations:\r\n<ul>\r\n \t<li>Increased goal-concordant care<\/li>\r\n \t<li>Increased patient and family satisfaction with care<\/li>\r\n \t<li>Better preparation for making treatment decisions, even in challenging and time-sensitive situations<\/li>\r\n \t<li>Improved patient quality of life<\/li>\r\n \t<li>Reduction in the use of non-beneficial, intensive treatments<\/li>\r\n \t<li>Cost savings by avoiding unnecessary treatments<\/li>\r\n \t<li>Enhanced healthcare provider-patient relationships<\/li>\r\n<\/ul>\r\nClinician identified barriers to GOC discussions in LTC settings:\r\n<ul>\r\n \t<li>Caregiver reactions and treatment understanding<\/li>\r\n \t<li>Lack of time for conversations<\/li>\r\n \t<li>Residents not having advance care planning<\/li>\r\n \t<li>Inadequate documentation of previous GoC conversations[footnote]Choosing Wisely Canada, n.d.[\/footnote][footnote]Jacobsen et al., 2022[\/footnote][footnote]Clarke et al., 2023[\/footnote][footnote]Siu et al., 2020a[\/footnote][footnote]Nova Scotia Health, 2023[\/footnote]<\/li>\r\n<\/ul>","rendered":"<p>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\u2019s caregiver<a class=\"footnote\" title=\"Jacobsen et al., 2022\" id=\"return-footnote-983-1\" href=\"#footnote-983-1\" aria-label=\"Footnote 1\"><sup class=\"footnote\">[1]<\/sup><\/a><\/p>\n<p>Serious Illness conversation is not just:<\/p>\n<ul>\n<li>Code status conversations<\/li>\n<li>Conversations to share prognosis, life expectancy and recovery statistics<\/li>\n<li>Conversations to make immediate medical decisions<\/li>\n<\/ul>\n<p>Challenges for Serious Illness conversations:<\/p>\n<ul>\n<li>Time pressures and complex life-saving procedures requiring acute decision-making<\/li>\n<li>Continuity of care<a class=\"footnote\" title=\"Harris et al., 2021\" id=\"return-footnote-983-2\" href=\"#footnote-983-2\" aria-label=\"Footnote 2\"><sup class=\"footnote\">[2]<\/sup><\/a><a class=\"footnote\" title=\"Cameron &amp; Laupacis, 2019\" id=\"return-footnote-983-3\" href=\"#footnote-983-3\" aria-label=\"Footnote 3\"><sup class=\"footnote\">[3]<\/sup><\/a><a class=\"footnote\" title=\"Vancouver Coastal Health, n.d.\" id=\"return-footnote-983-4\" href=\"#footnote-983-4\" aria-label=\"Footnote 4\"><sup class=\"footnote\">[4]<\/sup><\/a><a class=\"footnote\" title=\"Baxter et al., 2023\" id=\"return-footnote-983-5\" href=\"#footnote-983-5\" aria-label=\"Footnote 5\"><sup class=\"footnote\">[5]<\/sup><\/a><\/li>\n<\/ul>\n<div class=\"textbox textbox--exercises\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\">Optional Readings:<\/p>\n<\/header>\n<div class=\"textbox__content\">\n<ol>\n<li><a href=\"https:\/\/www.ariadnelabs.org\/resources\/downloads\/serious-illness-conversation-guide\/\">Serious Illness Conversation Guide<\/a><\/li>\n<li><a href=\"https:\/\/www.vitaltalk.org\/\">VitalTalk<\/a><\/li>\n<\/ol>\n<\/div>\n<\/div>\n<p>Benefits of early Serious Illness conversations:<\/p>\n<ul>\n<li>Increased goal-concordant care<\/li>\n<li>Increased patient and family satisfaction with care<\/li>\n<li>Better preparation for making treatment decisions, even in challenging and time-sensitive situations<\/li>\n<li>Improved patient quality of life<\/li>\n<li>Reduction in the use of non-beneficial, intensive treatments<\/li>\n<li>Cost savings by avoiding unnecessary treatments<\/li>\n<li>Enhanced healthcare provider-patient relationships<\/li>\n<\/ul>\n<p>Clinician identified barriers to GOC discussions in LTC settings:<\/p>\n<ul>\n<li>Caregiver reactions and treatment understanding<\/li>\n<li>Lack of time for conversations<\/li>\n<li>Residents not having advance care planning<\/li>\n<li>Inadequate documentation of previous GoC conversations<a class=\"footnote\" title=\"Choosing Wisely Canada, n.d.\" id=\"return-footnote-983-6\" href=\"#footnote-983-6\" aria-label=\"Footnote 6\"><sup class=\"footnote\">[6]<\/sup><\/a><a class=\"footnote\" title=\"Jacobsen et al., 2022\" id=\"return-footnote-983-7\" href=\"#footnote-983-7\" aria-label=\"Footnote 7\"><sup class=\"footnote\">[7]<\/sup><\/a><a class=\"footnote\" title=\"Clarke et al., 2023\" id=\"return-footnote-983-8\" href=\"#footnote-983-8\" aria-label=\"Footnote 8\"><sup class=\"footnote\">[8]<\/sup><\/a><a class=\"footnote\" title=\"Siu et al., 2020a\" id=\"return-footnote-983-9\" href=\"#footnote-983-9\" aria-label=\"Footnote 9\"><sup class=\"footnote\">[9]<\/sup><\/a><a class=\"footnote\" title=\"Nova Scotia Health, 2023\" id=\"return-footnote-983-10\" href=\"#footnote-983-10\" aria-label=\"Footnote 10\"><sup class=\"footnote\">[10]<\/sup><\/a><\/li>\n<\/ul>\n<hr class=\"before-footnotes clear\" \/><div class=\"footnotes\"><ol><li id=\"footnote-983-1\">Jacobsen et al., 2022 <a href=\"#return-footnote-983-1\" class=\"return-footnote\" aria-label=\"Return to footnote 1\">&crarr;<\/a><\/li><li id=\"footnote-983-2\">Harris et al., 2021 <a href=\"#return-footnote-983-2\" class=\"return-footnote\" aria-label=\"Return to footnote 2\">&crarr;<\/a><\/li><li id=\"footnote-983-3\">Cameron &amp; Laupacis, 2019 <a href=\"#return-footnote-983-3\" class=\"return-footnote\" aria-label=\"Return to footnote 3\">&crarr;<\/a><\/li><li id=\"footnote-983-4\">Vancouver Coastal Health, n.d. <a href=\"#return-footnote-983-4\" class=\"return-footnote\" aria-label=\"Return to footnote 4\">&crarr;<\/a><\/li><li id=\"footnote-983-5\">Baxter et al., 2023 <a href=\"#return-footnote-983-5\" class=\"return-footnote\" aria-label=\"Return to footnote 5\">&crarr;<\/a><\/li><li id=\"footnote-983-6\">Choosing Wisely Canada, n.d. <a href=\"#return-footnote-983-6\" class=\"return-footnote\" aria-label=\"Return to footnote 6\">&crarr;<\/a><\/li><li id=\"footnote-983-7\">Jacobsen et al., 2022 <a href=\"#return-footnote-983-7\" class=\"return-footnote\" aria-label=\"Return to footnote 7\">&crarr;<\/a><\/li><li id=\"footnote-983-8\">Clarke et al., 2023 <a href=\"#return-footnote-983-8\" class=\"return-footnote\" aria-label=\"Return to footnote 8\">&crarr;<\/a><\/li><li id=\"footnote-983-9\">Siu et al., 2020a <a href=\"#return-footnote-983-9\" class=\"return-footnote\" aria-label=\"Return to footnote 9\">&crarr;<\/a><\/li><li id=\"footnote-983-10\">Nova Scotia Health, 2023 <a href=\"#return-footnote-983-10\" class=\"return-footnote\" aria-label=\"Return to footnote 10\">&crarr;<\/a><\/li><\/ol><\/div>","protected":false},"author":517,"menu_order":33,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-983","chapter","type-chapter","status-publish","hentry"],"part":3,"_links":{"self":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/npltc\/wp-json\/pressbooks\/v2\/chapters\/983","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\/983\/revisions"}],"predecessor-version":[{"id":986,"href":"https:\/\/pressbooks.library.torontomu.ca\/npltc\/wp-json\/pressbooks\/v2\/chapters\/983\/revisions\/986"}],"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\/983\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/npltc\/wp-json\/wp\/v2\/media?parent=983"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/npltc\/wp-json\/pressbooks\/v2\/chapter-type?post=983"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/npltc\/wp-json\/wp\/v2\/contributor?post=983"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/npltc\/wp-json\/wp\/v2\/license?post=983"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}