Tuesday, August 2, 2011

Communicating to physicians goals of care

Goals of care worksheet.

In geriatrics, there are so many issues to consider before deciding what is best for a patient. Nothing is more important than the goals that a patient defines for himself. While the effectiveness of treatments change as a person ages, and social situations and other medical problems can affect what is best, achieving a patient's goals should be the primary aim of a medical plan. The goals may vary based on what type of medical interventions a patient can tolerate, whether they want to live longer vs more comfortably.

The link is to a worksheet that I wrote that I hope will help people communicate goals to their physicians. The concern is that physicians can look at an older person and make two really wrong assumptions: that a older person is too old for certain interventions or that they should be treated like a 45 year old. Neither is right. A person should receive a treatment that is appropriate and that largely depends on what they want and their goals.

Edit:
Two things missing that have been suggested: spiritual beliefs and some sort of question about where a person, ideally, would like to spend their last days.

4 comments:

retro said...

Very well thought out job aid - you should trademark it :) Also appreciate your position about focusing on the patient's goals - good advice and a great way to put people first.

Linsey said...

This came together really well and looks great! I like the layout, and the material is all very concise and direct. Very patient-oriented. When are you going to start using it ?

robin said...

At what point in time do you envision this being used? When a patient is new to an MD and has already decided to see that MD going forward? And when patient goals have changed -- due to illness, etc?

joshuy said...

I would say this applies to those who have more complicated goals of care. Mine is simple, I'm in good health and I want aggressive care for example. This would not apply really for someone likeme.
2nd group would be those with strong preferences.
3rd group would be those who have had a recent new major illness or change in prognosis
4th would be those who have had trouble communicating with their physicians assuming that the patient would want more or less agressive care than they would really want.