Discussing Goals of Care: Why

00:01 In this lecture, we're going to talk about goals of care discussions.

00:04 We talk about goals of care as a way to think about the informed consent process.

00:09 In light of the patient's goals.

00:11 You know, who they are as a person? what they're hoping to accomplish in their life? What provides them meaning in life? That's the reason we think about this larger framework of goals of care.

00:23 So why do we do it? First of all, it's a way to establish ground rules of how we're going to share information.

00:30 So as you heard in the breaking bad news or breaking serious news lecture, there's an opportunity to figure out how much information a patient wants to receive in the therapeutic relationship? So goals of care is a way to help establish those ground rules.

00:46 It's also a way to help prevent surprises.

00:50 So, if you think of illness as sort of a journey, that's like planning a trip.

00:55 So you need to anticipate you know, what if something goes wrong on the journey? How are we going to deal with that? What are you hoping to achieve? You know, what are you hoping to see on this trip that you're going on? Again, way to put an overall framework of how the patient views their illness, the treatment plan, and figuring out what their goals are.

01:18 There may be a time where there are decision points along the way, as you can sort of anticipate based on their diagnosis.

01:27 What treatment decisions might need to come in the future? So this is a way to sort of talk about those in advance, so that the patient is then prepared to think about them.

01:36 You know, they might have thoughts in the moment about how to handle those.

01:40 But it's also a way to help in that preparation.

01:43 The goals of care discussion is also a way to help the patient articulate their hopes and their fears.

01:48 So what are they hoping for? What are they hoping for in their disease management? But also, what are they hoping for in their life or their important milestones in their family or in their life that they hope to achieve? Are they fearful of certain things? Do you want to try to get those out in the open? So if you can help them with their fearfulness and get them through that anxiety that they might have about what the information or the treatment plan or the diagnosis itself? How they're going to deal with those fears? There's also an opportunity to sort of create tangible milestones.

02:24 So if we start this treatment plan, what are we hoping to see in a week or a month or a year? Having these tangible milestones to look back on and say, "Remember those goals or care discussions we had? Can you think about those now in terms of what's been going on?" And it's also an opportunity when, you know, again, this is a journey.

02:45 So, when new events occur, when there's something new, the patient has a new symptom.

02:50 A new treatment has to be considered.

02:52 This is an opportunity to take stock of, "Okay, we've had these prior goals of care discussions.

02:57 Now let's try to reflect on those with these new events, with these new situations, and how we're going to handle those?