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goals of care

Patient's preferences or priorities for treatment of illness. goals of care include longevity, function, & quality of life Component of one of the 5 Ms of geriatrics Clinical significance: - a 1st step in counseling a patient about treatment options & a care plan - goals of care discussions with serious illness promote patient-centered outcomes at the end of life [1] Complications: - goals of care are too frequently not transferred across care settings Management: - as 'what is your understanding of where you are with your illness?' - in the absence of established goals of care (advance directives) or an available surrogate decision maker, full resuscitation efforts are indicated [2] Clinical trials: - a randomized clinical trial (electronic health record-based) to promote goals-of-care discussions had litte impact on occurrence of discussions [1]

Related

advance directives shared decision making; patient preferecnce

Specific

goal of remaining in home

References

  1. Curtis JR et al. Intervention to promote communication about goals of care for hospitalized patients with serious illness: A randomized clinical trial. JAMA 2023 May 21; [e-pub]. PMID: 37210665 https://jamanetwork.com/journals/jama/fullarticle/2805346 - White DB, Andersen SK. Conversations on goals of care with hospitalized, seriously ill patients. JAMA 2023 May 21; [e-pub]. PMID: 37210664 https://jamanetwork.com/journals/jama/fullarticle/2805347
  2. NEJM Knowledge+
  3. Boyd C, Smith CD, Masoudi FA et al. Decision Making for Older Adults with Multiple Chronic Conditions: Executive Summary for the American Geriatrics Society Guiding Principles on the Care of Older Adults with Multimorbidity. J Am Geriatr Soc. 2019;67(4):665-673 PMID: 30663782 https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.15809
  4. Bernacki RE, Block SD; American College of Physicians High Value Care Task Force. Communication about serious illness care goals: a review and synthesis of best practices. JAMA Intern Med. 2014 Dec;174(12):1994-2003 PMID: 25330167 Review.
  5. Jacobsen J, Bernacki R, Paladino J. Shifting to Serious Illness Communication. JAMA. 2022 Jan 25;327(4):321-322. doi: 10.1001/jama.2021.23695. PMID: 34994773 No abstract available. https://jamanetwork.com/journals/jama/fullarticle/2788065
  6. Jain N, Bernacki RE. Goals of Care Conversations in Serious Illness: A Practical Guide. Med Clin North Am. 2020 May;104(3):375-389. PMID: 32312404 Review.