Goals, Not Problems, Drive Care
Throughout the experience of illness, patients and families' goals
for care and treatment priorities will vary considerably. Most
patients will want to mix:
- Therapies intended to modify (fight) their disease (whether it has a
curative, restorative, or palliative intent)
- Therapies and assistance to maintain function and relieve the suffering they experience
from the manifestations of their disease and the predicament in which they find themselves
- Assistance to identify and realize the opportunities created by their illness
For most people, ongoing quality of life and the capacity to carry
on their roles and have meaningful and valuable experiences for as
long as possible will be of utmost importance.
There will be variable approaches to fighting disease. Some people will want to fight
aggressively to the end, including desiring artificial life support. Others will want
minimal disease-modifying therapy.
Some prefer not to prolong life or the dying process once they realize
that they have no capacity to live as they would like.
Setting overall goals is key if an appropriate balance between disease-oriented
treatments and those intended to maintain function and relieve suffering. This
requires a
shift in thinking from problem-based to goal-oriented medical care.
Goals are sometimes mutually exclusive or overlapping. The desire to
have no pain yet undergo an operation to relieve a blocked coronary
artery may not be possible. It is the task of the physician to
identify the issues and communicate clearly to help the patient and family understand
their situation and prognosis, to establish goals for care
and treatment priorities.
Patients and families have come to expect
competence and expertise.
Resource:
EPEC Module 7: Goals of Care
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CAPCManual Attribution:
von Gunten CF,
Ferris FD,
Portenoy RK,
Glajchen M, eds.
CAPCManual: How to Establish A Palliative Care Program.
New York, NY: Center to Advance Palliative Care, 2001.
©
Center for Palliative Studies, San Diego Hospice & Palliative Care, San Diego, CA
and
The Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, NY, 2001
Permission to reproduce for non-commercial educational purposes with display of
attribution and
copyright is granted.
Last updated: February 20, 2002
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Rationale
Select section:
Changing Illness Experience
Changing Expectations and Needs
Progressive Healthcare Response
Responding to the Opportunity
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Changing Illness Experience
Illness in the Past
Progress Fighting Disaese
Illness Today
Prolonged Illness Experience
Chronic Disease Process
Determining Prognosis
Cancer
Manifestations
Predicament
Prolonged End-of-life Experience
Sudden Unexpected Death
Predictable Decline
Slow Decline, Multiple Acute Crises
Death in the US
Leading Causes of Death
Setting of Death
Desired
Reality
Multiple Issues Cause Suffering
The Square of Care
Morbidity
Pain
Need for Assistance
Social, Financial Impact
Implications for Care
Variable Need for Care
Opportunities
For Patients
For Families
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Changing Expectations and Needs
Increased Consumer Autonomy
Picker Institute 8 Dimensions of Care
Goals Drive Care
Shift to Goal-oriented Care
Expect Competence, Expertise
Expect Comprehensive Assessment
Expect Effective Communication
Expect Participation in Decision-making
Expect Timely, Continous, Coordinated Care Delivery
Expect Assistance with Caregiving
Caregiver Training, Support
Caregiver Financial Support
Alternate Settings of Care
Respite Relief
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Progressive Healthcare Response
Focus on Disease-modifying Therapy
Focus on Care of the Dying
Early Hospice
Modern Hospice Movement
Dame Cicely Saunders
Origins of "Palliative Care”
Evolution of Hospice, Palliative Care
In United Kingdom
In Canada
In United States
Convergent Evolution
Hospice, Palliative Care in US Today
Hospice Growth
Continued Unmet Opportunity
A Public Health Issue
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Responding to the Opportunity
Paradigm Shift in Thinking
Provide Concurrent Care
Consider Application to Those at Risk
Expand Services, Settings of Care
1º, 2º, 3º Model of Delivery
Expand Access to Expertise
Create Specialized Environments
Many Names, Same Focus of Care
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