Discussing Goals of Care: Who

00:01 So that's the why. And now we have to think about well, who? Who is going to be involved in these goals, care discussions? So, first and foremost, obviously, is going to be the patient.

00:10 We need to hear about, what's meaningful in their life? Who they are as a person? What they're hoping to accomplish? There's also the opportunity in these conversations to involve family or loved ones, who the patient values.

00:24 That could be a person that's going to help them with decision making.

00:28 So, they can bounce ideas off that person and see how they're thinking about whatever recommendations we're giving.

00:35 It could be a person that we sort of anticipate might be a surrogate decision maker for the patient of proxy, or health care agent for them in the future.

00:45 And that person needs to be informed of the diagnosis, the treatment plan, the recommendations, in case they need to make decisions for the patient in the future.

00:56 It's also a recognition that, yeah, there may be times when the patient will lose capacity in the future.

01:02 And we're going to need to rely on a person they trust to make decisions on their behalf.

01:07 So the who in the goals of care discussions.

01:10 Number one is the patient but also any other person that they value and trust to help them with decision making.

01:20 Why would you involve loved ones in any kind of decisions or in health care decisions in particular? Well, it's an extra set of ears.

01:28 So you know, maybe the patient, and the doctor or the clinician are talking to each other.

01:34 But having that other person in the room can hear the information, maybe process it in a little different way than the patient.

01:41 The patient might be having an emotional reaction to the information that's being given.

01:46 This loved one that they trust, as that extra set of ears to maybe process it in a different way.

01:51 They may be the person that can prompt the difficult questions.

01:55 So the question that the patient is afraid to ask or doesn't think to ask that the loved one can make those questions, really make them a parent, and make sure that they get expressed.

02:07 It's an opportunity for the patient to share the burden of decision making with someone else.

02:13 So it's not all on their shoulders, but they can rely on this trusted person to help them with decision making.

02:18 And then, as we've talked about, this idea that there might be a surrogate decision maker in the future, you know, it's best when that's done when you're making decisions on behalf of the patient, that it's, you're using substituted judgment.

02:31 We talked about that in the informed consent lecture.

02:34 This is an opportunity.

02:35 I understand the patient's wishes. I understand their preferences.

02:39 I'm now needing to make decisions for them.

02:42 I'm substituting my judgment on their behalf.

02:44 This is how they would make the decision if they could.

02:47 And it's also an opportunity, well, if the patient's had prior goals of care discussions I've been involved in, now, I have to make the decision.

02:54 I don't really know how they make it.

02:56 I need to make it based on best interests.

02:58 This is a way for the loved one sort of know the context of prior decisions when they have to make those decisions in the future.