00:01 The next step in the goals of care discussion to think about is the where. 00:04 So this might happen in the outpatient setting. 00:08 So you're seeing the patient in the ambulatory clinic environment. 00:14 There, there might be their current treatment plan. 00:18 You're just having these goals of care conversations in relation to those particular treatments. 00:24 Or it's also an opportunity to sort of look into the future and say, as part of an advanced care planning process, we need to think about goals of care. 00:33 Maybe there's not an immediate decision that needs to be made, but we can sort of anticipate future goals of care discussions. 00:39 So, having these opportunities in the outpatient setting when the patient can go home reflect on these things, is an important aspect of the where and goals of care. 00:51 It may also happen in the inpatient setting. 00:53 Certainly when a person has an acute illness and needs to be hospitalized. 00:57 This is an opportunity to say, "Okay, this is what we're trying to achieve during your hospitalization. 01:02 How does this fit in with your overall goals of care?" Maybe the patient has chronic illness. 01:10 They've got heart failure, and now they've had an exacerbation of their heart failure. 01:15 They're needing to be hospitalized for this. 01:17 Maybe there have been prior goals of care discussions. 01:20 Now we need to have a new goals of care discussion based on an exacerbation of this chronic illness. 01:26 Perhaps a patient is needed to go in for a procedure or for an operation. 01:31 Hopefully, everything's going to turn out great. 01:34 They're going to get through the surgery just fine. 01:36 But maybe you need to anticipate, well, what if there are complications? What if there are side effects? We need to have goals of care discussion, I need to know. 01:44 What do we do in case a complication arises? How does this fit in with your perioperative management? Maybe they've had decisions already about, you know, not wanting certain life sustaining treatments. 01:56 Like not wanting cardiopulmonary resuscitation, and they're going into an operation. 02:01 Well, what if the anesthesia causes a cardiac arrest? Would you want there to be resuscitation in those circumstances knowing that it might be reversible, because the anesthesiologist is right there to respond to the emergency? Has a patient gets much sicker when they become critically ill? Maybe they're in an intensive care unit, this is another opportunity for goals of care discussions. 02:24 What are we trying to achieve in the intensive care that they're getting in that setting? Maybe the patient's not able to participate in those conversations, but it's a family member. 02:35 So, again, having goals of care discussions with them. 02:38 And then lastly, maybe the patient's recovered during their hospitalization. 02:42 You're anticipating that they're going to be discharged. 02:45 They're going to be a transition of care, back to the ambulatory setting or maybe to another healthcare facility. 02:51 You also want to sort of clarify the goals of care in anticipation of that hospital discharge.
The lecture Discussing Goals of Care: Where by Mark Hughes, MD, MA is from the course Breaking Serious News and Advance Care Planning.
What is the reason for exploring goals of care in an outpatient setting?
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