The Goal Setting Conference Page 2
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2THE GOAL SETTING CONFERENCE
“What do you wish to accomplish?”
ASSESS PATIENT/FAMILY GOALS
7.
“Are there any important goals or tasks left undone?”
Possible goals:
“What is most important to you at this time?”
• prolong life
● see a family milestone
“Knowing that time is short, what goals do you have?”
• improve function
● relief of suffering
“How do you picture your death?”
• return home
● staying in control
“Where do you want to be when you die?”
“Given what you have told me, about your mother and her goals, I
PRESENT BROAD CARE OPTIONS
8.
would recommend . . .”
• Stress priority of comfort, no matter the goal
“These decisions are very hard; if (patients name) were sitting with us
• Make a recommendation based on knowledge/experience
today, what do you think he/she would say?”
“How will the decision affect you and other family members?”
“You have told me your goals are ____ With this in mind, I do not
TRANSLATE GOALS INTO CARE PLAN
9.
• Review current and planned interventions-make
recommend the use of artificial or heroic means to prolong your dying
process. If you agree with this, I will write an order in the chart that
recommendations to continue or stop based on goals
when you die, no attempt to resuscitate you will be made, is this
• Discuss DNR, Hospice/Home Care, Artificial
acceptable (ok)?”
Nutrition/Hydration, future hospitalizations
“All dying patients lose their interest in eating in the days to weeks
• Summarize all decisions made
leading up to death; this is the body’s signal that death is coming.”
“I am recommending that the (tube feedings, IVF) be discontinued (or
CONFIRM YOUR CONTINUED AVAILABILITY
not started) as these will not improve her living and may only prolong her
REGARDLESS OF DECISIONS
dying.”
Team debriefing = Opportunity for Teaching and Reflection
DOCUMENT AND DISCUSS
10.
• Write a note: who was present, what decisions were made,
Ask team members:
“How do you think the meeting went?” “What went well?” What could
follow-up plan
have gone more smoothly? “What will you do differently in the future?”
• Discuss with team members (consultants, nurse, etc.)
• Check your emotions
MANAGING CONFLICT
Listen and make empathic statements
Determine source of conflict: guilt, grief, culture, family, dysfunction, trust in med team, etc.
Clarify misconceptions
Explore values behind decisions
Set time-limited goals with specific benchmarks (e.g. improved cognition, oxygenation, mobility)
WHEN YOU NEED ADDITIONAL ASSISTANCE OR SUPPORT CONSIDER A PALLIATIVE CARE CONSULT
Palliative Care Service consult pager: (917) 632-6906 or 9399
Adapted from Weissman, DE “The Family Goal Setting Conference” and “Communication Phrases Near the End of Life” pocket cards from Medical College of Wisconsin
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Parent category: Life