Wednesday, October 7, 2015

Canada needs to develop standards for Goals of Care conversations - Healthy Debate

"The process of determining my Grandma’s preferences for specific medical treatments in the face of illness is known as Advanced Care Planning, which is discussed as part of a larger Goals of Care conversation. These discussions attempt to focus on a shared understanding of the patient’s values and treatment preferences to develop advanced directives aligned with the patient’s goals and wishes. When patients engage in advance care planning they are more likely to receive palliative care and appropriate end-of-life care in the community. As a result, they are more likely to die at home or in their LTC facility rather than in hospital, and have improved quality of life and satisfaction with their end-of-life care. They also have a reduced likelihood of receiving hospital care and a reduced number of days spent in the hospital. Conversely, poor communication leads to increased incidence of hospital admissions, medical errors, and poor health outcomes.

But this critically important discussion, and the seemingly simple definition of what constitutes a Goals of Care conversation is as infinitely complex as the patients who we have them with. Like many things in medicine, it requires a specialized skill set requiring training and experience. And herein lies the inherent conflict – determining a patient’s preferences for treatment is something all physicians do, yet our degree of training and perspectives on who should determine them can vary widely.

The result is that there is huge variability in how these conversations are conducted, and no established guidelines from experts in the field on how to conduct them."

Canada needs to develop standards for Goals of Care conversations - Healthy Debate

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