The Goal Setting Conference
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1
2THE GOAL SETTING CONFERENCE
BEFORE THE MEETING
Review chart-know all medical issues: history, prognosis, treatment options
Coordinate medical opinions among consultant physicians
Decide what tests/treatments are medically appropriate (i.e., likely to benefit the patient)
Review Advance Care Planning documents
Review/obtain family psychosocial information
Decide who you want to be present from the medical team
Clarify your goals for the meeting-what decisions are you hoping to achieve?
10 STEP GUIDE
HELPFUL LANGUAGE
ESTABLISH PROPER SETTING
1.
Private, comfortable; Everyone seated, Turn off/forward pager
“Can you tell me something about your father? What kind of person is
INTRODUCTIONS
2.
he?”
• Allow everyone to state name and relationship to patient
• Build relationship: ask non-medical question about patient
“What have the doctors told you about your wife’s condition at this
ASSESS PATIENT/FAMILY UNDERSTANDING
3.
point?”
• Encourage all present to respond
“What is your assessment of the current medical situation?”
• Ask for a description of changes in function over course of
illness/hospitalization
“I’m afraid I have some bad news. I wish things were different. Based
MEDICAL REVIEW/SUMMARY
4.
on what you have told me, and what I see, I believe your mother is
• Summarize “big picture” in few sentences- use “dying” if
dying”
appropriate; avoid organ-by-organ medical review
• Avoid jargon
• Answer questions
“This must be very hard”
SILENCE/REACTIONS
5.
“I can only imagine how scary/difficult/overwhelming this must be”
• Respond to emotional reactions (have tissues available)
“You appear angry, can you tell me what is upsetting you?”
• Prepare for common reactions: acceptance, conflict/denial,
grief/despair; respond empathically
“Some people like to know every detail about their illness, others prefer
DISCUSS PROGNOSIS
6.
a more general outline. What kind of person are you?”
• Assess how much patient and family want to know
“Although I can’t give you an exact time, given your illness and
• Provide prognostic data using a range
condition, I believe you have (hours to days) (weeks to months).
• Respond to emotion
This is an average, some live longer and some live shorter”
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Parent category: Life