Goals of Care

Goals of care describes the aim of medical treatment for the patient. Goals of care:

Should be established between the patient, family, carers, and the treating team
Reflect what matters to the patient, and what they want to achieve with their healthcare
Aim to ensure that patient’s are cared for in the way they would want to be, when communication may no longer be possible
May change over time
Do not apply just to end of life care
Important goals may include:
- Nature of medical interventions
- Place of care
- Incorporating patient values

Discussing Treatment Limitations

Discussing goals of care should occur:

Ideally for all patients on hospital admission
This normalises the process of the discussion, and encourages patients to have the discussion talk about their wishes with their families.
Specifically for patients who have advanced:
- Malignancy
- Frailty
- Physiological age (>85 years old)
- Other terminal disease
When it is unclear whether treating a clinical problem will be of benefit to a patient
The risks and benefits of different options should be explained, and the decision should be guided by the patient. There is no obligation to provide futile therapy.
When the patient requests it

Limitations of Medical Treatment

Limitations of medical treatment become relevant when the goal of medical care is not solely the preservation of life. Common categories of goals include:

My preferred approach is to conduct the goals of care discussion using a framework of shared decision making process (see Shared Decision Making), and then retrofit this to the limitations of treatment form. This prevents this activity turning into a tickbox exercise, and ensures the discussion is framed around goals rather than specific treatments.

Curative, with limitations
Overall treatment aim is curative, but resuscitative methods are not consistent with the patients wishes wishes. Treatment limitations may include:
- Not for CPR, but for respiratory support
- Not for CPR or intubation
  Therefore not for Code Blue, but for MET calls.
- For transfer to hospital
Palliative
Treatment aim is quality of life. Treatment limitations may include:
- Not for CPR or intubation
- For MET calls for lack of symptom control only
- May or may not be for transfer to hospital
Comfort during dying
Treatment limitations may include:
- Not for CPR or intubation
- For MET calls for lack of symptom control only

References

Australian Commission for Safety and Quality in Healthcare. Comprehensive Care Standard End-of-life care: clinical basics. 2024.
Lynn J, Adamson DM. Living Well at the End of Life:Adapting Health Care to Serious Chronic Illness in Old Age. RAND Corporation; 2002 Dec [cited 2024 Feb 1].