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GENERAL PRINCIPLES OF GOALS OF CARE DISCUSSIONS

Goals of care discussions provide a broad framework for decision making, helping align patients’ underlying values and hopes with the realistic and achievable options for care given the current medical circumstances. This is no easy task, however, as patients and their family members may simultaneously express multiple goals for their health care, which may include maintenance of independence, prevention of illness, prolongation of life, relief of suffering, and maximization of time with family and friends. The relative importance placed on each goal may change over time as new information is shared with the patient or family, such as a new diagnosis or a worsening prognosis. These goals should serve as a guide from which patients and their physicians can develop specific plans for treatment when dealing with acute or chronic illnesses.

A PRACTICAL GUIDE TO GOALS OF CARE DISCUSSIONS

Goals of care can provide a guide for various decisions, including immediate decisions regarding life-sustaining treatments and decisions regarding preferences for preventive therapies such as cancer screening, and for the completion of advance directives. There is no one right way of having these discussions; however, the following outlines seven practical steps for having a discussion (see Table 4–1 for words to use, and Table 4–2 for words to avoid).

Table 4–1.Words that may be useful when discussing goals.

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