Serious illness communication (often referred to as advanced care planning) is the foundation of successful treatment for patients who have serious or chronic illnesses. These conversations clarify what matters to a patient and their loved ones in order to guide decision-making and strengthen the relationship between a patient and their care team. Robust evidence shows that when you align with patients’ goals of care, satisfaction, quality of life, and even outcomes improve.
What are “Goals of Care” Conversations?
“Goals of care” conversations help a patient clarify their individual values, priorities, and preferences for future medical care. This can help you answer questions with them, like:
- What outcomes matter most to this patient?
- How do they define quality of life?
- What trade-offs are they willing to make? Which aren’t they willing to make?
- What are the patient’s wishes regarding specific interventions like resuscitation or mechanical ventilation?
Consider both physical and mental health and impacts on everyday life and activities beyond clinical outcomes. For people with chronic conditions, a shared understanding of goals can help them weigh their options, especially when prognosis, treatment burden, or life circumstances change. Proactive conversations take away some of the guesswork.
What Patients Should Consider Goals of Care?
Though any patient can benefit from considering the goals of their care, it is especially critical for individuals with serious, chronic, or progressive conditions — not just those near the end of life.
When these conversations happen early and regularly, patients and their families can prepare for major decision points, you can minimize unnecessary interventions, and patients’ trust in your care increases. Carefully addressing goals of care is an act of excellence in both clinical care and human compassion.
What Does the Evidence Show?
There is robust evidence that supports the clinical and interpersonal value of conversations about goals of care. Benefits include:
- Increased goal-concordant care
- Improved quality of life
- Reduced patient and family distress
- Enhanced satisfaction
Some may worry that these conversations will negatively affect patients’ and families’ mental health. It is important to note that the literature does not support the concern that these conversations increase patient distress; rather, they help patients retain a sense of control. Interventions that prime both clinicians and patients to think about goals of care increase the likelihood that a discussion happens.
Tips
- Start small. Patients struggle to identify their priorities in the midst of their situation. Open with a simple, concrete question like
“What is one thing that you would consider a success in your treatment?”
- Provide support. Provide informative pamphlets or direct people to a trusted online resource to help patients work through their values and goals outside of the clinical setting.
- Consider a structured conversation. A guide like the Serious Illness Conversation Guide or the REMAP framework can normalize difficult conversations and reduce uncertainty for both you and your patients.
Goals-of-care conversations support patient autonomy and engage them meaningfully in their care. Take the first step to support your patients with chronic, progressive, and serious conditions by discussing goals of care with them.