When you talk about your Goals of Care Designation (GCD) with your healthcare provider, they will tell you about 3 general approaches to care: medical care, comfort care, and resuscitative care. Each approach has sub-categories that further define care goals, wishes, and values. The following information can help you prepare for this conversation with your healthcare provider. You can also
watch a video about the 3 goals of care to learn more.
Medical Care (M)
In this approach to care, you’re expected to benefit from and value any appropriate medical tests and treatments that can be offered, excluding a stay in the
intensive care unit (ICU) and resuscitative care (see more about resuscitative care below). Locations for care (such as at home, hospital, and a care facility) are considered depending on what is medically appropriate and in keeping with your wishes and values.
M1
M1 means using any appropriate medical and surgical treatments, including going to the hospital, to try to “fix the fixables” with a focus to live as long as possible and maintain your desired quality of life. The team will not use pushing on the chest (CPR), a breathing machine (ventilator), or the intensive care unit (ICU). M1 says that there are limits to what resuscitation and life support can do for you.
M1 is appropriate for people who are unlikely to survive an attempted resuscitation, or when resuscitation is unlikely to leave them in a state of living they value.
M2
M2 means you will be treated at home or a care facility and avoid hospital admission. Medical treatments available in your home or a care facility will be used to try to “fix the fixables.” If you don’t respond to home-based treatments, your healthcare team will talk to you about re-evaluating your wishes and goals, which may include changing your focus of care to comfort care (see more about comfort care below).
M2 is for people who are frail or chronically (long-term) ill and their health is more likely to get worse rather than improve with going to the hospital. It’s also appropriate for people who no longer want the kind of treatments available in the hospital or when being in the hospital is unlikely to leave them in a state of living they value.
Comfort Care (C)
In this approach to care, the aim of medical tests and treatments is to manage symptoms of the disease and maintain function when cure or control of an underlying condition is no longer possible or desired. Transfer to a hospital may occur in order to better understand or control symptoms.
C1
C1 means that the focus of your care is to provide comfort and control your symptoms. Medical treatments focus on giving you the best quality of life possible, rather than focusing on length of life.
C1 is appropriate for people who are very frail or living with serious illness and are unlikely to respond to medical treatments for prolonging life. It’s for people who want to focus on quality of life more than length of life.
C2
C2 means that you are in the final hours or days of life, and all treatments are focused on your comfort and support of those close to you. It’s only for people who are
imminently dying (meaning in the final hours or days of life) and treatments can
no longer help them live longer.
Resuscitative Care (R)
In this approach to care, any appropriate medical tests and treatments that can be offered —including the intensive care unit (ICU) and resuscitation (pushing on the chest or CPR)—and that are likely to help you will be used.
R1
R1 means that any appropriate medical and surgical treatments—including CPR, a breathing machine (ventilator), and ICU—will be used to try to prolong your life during a critical illness.
R1 is appropriate for people who are likely to recover from an illness and return to how they were before. They want this attempt made to prolong life, even if it may leave them with lasting changes to their health and abilities.
R2
R2 means that any appropriate medical and surgical treatments, including a stay in intensive care and breathing machine, will be used to try to prolong your life during critical illness. The team will
not use CPR.
R2 is appropriate for people whose heart is unlikely to restart if it stops, but they have an illness that might benefit from a breathing machine and intensive care. R2 is also appropriate when CPR is unlikely to leave a person in a state of living that they value.
R3
R3 means that any appropriate medical and surgical treatments, including a stay in the ICU, will be used to try to help you live longer. The team will
not use CPR or a breathing machine.
R3 is appropriate when CPR and a breathing machine are unlikely to help a person live longer, but their illness might respond to other intensive care treatments. R3 is also used when CPR and a breathing machine are unlikely to leave a person in a state of living that they value.
