Goals of care designations – Transcript

Goals of care are designations used by your healthcare providers to describe the general aims of your healthcare and the preferred location of that care.

Decisions about goals of care usually arise over time, through conversations between you, your family or loved ones, and your healthcare team.

The process of thinking about, talking about, and documenting your wishes for healthcare is called advance care planning.

In a medical emergency, your goals of care designation guides your healthcare team to provide timely care that is both medically appropriate and reflects your personal values and wishes.

There are 3 general approaches to care or goals of care: resuscitative care, medical care, and comfort care.

In resuscitative care, the main goal of care is to prolong life by curing or controlling your health condition.

This means that doctors and nurses could use intensive medical and surgical interventions if these are needed to keep you alive, and could be expected to cure or control your illness.

If your heart stops, they may perform cardiopulmonary resuscitation, or CPR.

You may have seen resuscitation or CPR performed on television or in the movies. The person usually recovers easily, but this doesn't tell the whole story.

Resuscitation measures like CPR work best in emergency situations where the heart stops suddenly, but the person is otherwise pretty healthy.

It's important to know that CPR normally cannot restart the heart or restore life when the heart has stopped as a result of a severe or terminal illness.

In CPR, the doctor or nurse repeatedly pushes on the chest with great force and periodically puts air into the lungs.

Electric shocks, called defibrillation, may also be used to restart the heart, and some medicines might also be given.

If the patient's heart starts to beat again, most patients require a stay in intensive care and a period of rehabilitation before they are well enough to leave hospital. And some people are left with permanent damage from their heart stopping.

Resuscitative care can also include using medications and other treatments that are provided in an intensive care unit or ICU.

The ICU is a very specialized unit in a hospital, with doctors and nurses who are trained in using special equipment and medications to care for very sick people.

An intervention that may be used in the ICU to prolong your life is a ventilating machine.

These machines are used if you're unable to breathe on your own.

This means putting a tube which is attached to a machine, down the throat, into the windpipe, to push air into your lungs.

Because this tube can be quite uncomfortable, people are often given medications to keep them very sleepy or sedated.

You cannot eat or talk while on this machine.

If you have a potentially curable or treatable condition, ICU care might be needed to help you heal.

The hope is that you will return to your previous health, but it is important to understand resuscitative care and procedures used with the aim of prolonging life may or may not achieve that aim of restoring your previous health.

In medical care, the goal of care is also to prolong life and to cure or control your health condition, but without the use of resuscitative care and the ICU.

Medical care can be appropriate if your health condition is such that intensive or resuscitative care such as CPR and a breathing tube are unlikely to work, or your wishes and values about healthcare may be that you would not be accepting of these intensive medical treatments. For example, if they are unlikely to restore you to a state of health that you would want.

In the medical approach to care, your doctors and nurses will provide tests and treatments for any treatable problems that may arise.

This approach may include surgery and medical treatments such as blood transfusions, kidney dialysis, feeding tubes, antibiotics, and other medicines or fluids given through your veins.

Most of these treatments mean going to the hospital.

Some people want to receive only the life prolonging treatments that can be provided in their home or in the care centre where they live, even if this limits what treatments are possible.

If your goals include a desire to avoid going to the hospital for treatment, talk to your doctor about what treatments may be available and helpful to you in your home or care centre.

When your health condition or your values and wishes reflect a goal of maximizing comfort and relieving symptoms, this approach is called comfort care.

Your doctors and nurses will give you medicines and other medical treatments to help control uncomfortable symptoms such as pain, trouble breathing, or feeling sick to your stomach.

The main goal is not to prolong life. It is to maximize your comfort. Resuscitative treatments are not used.

Comfort care does not mean that you receive less care.

It means the focus of your medical care is on quality of life and reduction of symptoms.

People receiving comfort care are usually treated at home, in hospice, or in a long term care centre.

However, sometimes hospitalization may be needed to provide optimum comfort.

In the hospital, the approach to care will continue to be focused on providing comfort and relieving symptoms.

It's helpful to keep in mind your wishes and to know about your own health condition when you are discussing goals of care.

Resuscitative care, medical care, and comfort care can be divided into more specific subcategories, called goals of care designations.

These subcategories provide your healthcare team with important information to help guide medical decisions about your treatment.

Talk to your healthcare team about which goals of care designation best reflects your wishes and health circumstances.​