Discussing Goals of Care: Where

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.