Monday, February 18, 2013

Another goals of care sheet

I am always looking to find a perfect form that would help me understand and help patients clarify their goals of care.  There are so many different values to discuss such as
Longevity goals
Quality of life goals  (both ideal and minimal)
Function goals (both ideal and minimal)
Comfort goals
Risk tolerance
Pain tolerance
Definition/purpose of suffering
Emotional issues
Cultural issues
Ideal place of death
Worries of abandonment vs desire for community
Views on technology (fear vs embrace)
Role with family (involved, independent)
Role with doctor (involved, independent)
          Model of decision making (informed consent vs paternalistic vs collaborative)
Concerns of being a burden to others (physically, emotionally)
Milestones to live for (an upcoming wedding/graduation/birth)
Dignity issues (care received, relationships, function)

There are a ton of medical decisions and implications that need to be made as well.   
Current health status
Projected health status/anticipated quality of life
Burden of medical interventions (both pain and risk)
In addition to a million individual decisions (Dialysis, ICU care, ER care, invasive testing, CPR etc)

I've made sheets of my own, but one that I am finding very very interesting is "The Conversation project."  I'm thinking of abandoning my own forms and using this one paired with a POLST form.  I'll let y'all know how it works out!

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