What Are "Goals of Care"?
The Control We Need
We all have goals and hopes for our lives. They define our purpose in life and help give us a sense of control. When we receive a diagnosis of serious illness, we feel out of control as we go from test to test, treatment to treatment. When the reality that treatment is no longer working finally sinks in, having goals of care can give back the control we need to face the final de la vida. Simply put, goals of care are our expectations and priorities about how we wish to live out the last months or days of life.¹
Goals of Care Equal Patient-Centered Care
Usually the physician will initiate a goals-of-care conversación while the patient is still in the hospital. This discussion focuses on exploring what the patient and family are expecting and hoping.
"We learn what the patient's choice is by having the goals-of-care conversation," says James Wright, DO, VITAS Healthcare regional medical director. "We tell our patients, 'We're going to provide care; what do you want that to be?' They know it won't be curative and they understand that. But maybe the goal is 'not to hurt anymore' or 'to feel as good as I possibly can.' The goals of care take clinical care and turn it into patient-centered care."
Goals of care include ways to relieve both physical and emotional suffering, to fulfill the wish to stay at home, and to help the patient live meaningfully to the end of their life. They also address support for the family and loved ones as well as making sure directivas anticipadas are in place.
Helping Achieve Personal Life Goals
Goals of care can also be linked to a patient's personal life goals. "Personal goals-such as attend a granddaughter's wedding or live to see the arrival of a new baby-we try to align those milestone goals with goals of care so the patient can live one more month, for example," says Eric Shaban, MD, VITAS Healthcare regional medical director. "It all comes together: we listen, they tell us what they want, we make it happen."
Once the goals of care are established, a plan of care can be implemented. As conditions changes, the goals of care transition gradually, adjusting to specific circumstances. Where the goal of care was once to maintain health and mobility, it may become making a bed-bound patient as comfortable as possible.
Goals of care are an important bridge of communication between patients, families and care providers. They are an established set of guidelines that always keep the needs and desires of the patient at the forefront of his or her care.
¹Stone, Marvin J., M.D. Goals of Care at the End of Life. Baylor University Medical Center Proceedings. Dallas. TX.