A #medthread #tweetorial on assessing goals of care. People often say “tell me your goals” and are confused when the response is “get better and go home” and conversation over.
First, until patients have been given reason to consider a goal beyond this (new bad news, disease progression, etc.), there probably isn’t any reason for a person to feel the need to reasses their own goals.
Second, “goals of care” is jargon and those words may not have meaning to a patient. What you really want to know our their values, hopes, and what gives life meaning. Ask about hobbies. How is life outside the hospital? Where do they get their strength?
When discussing hope, it’s ok to probe beyond hope for a cure. “I’m hoping for that too, but if that can’t happen, tell me what else you hope for?” Great paper by @danteismyguide in @NEJM about the many hopes patients and families can hold at one time. nejm.org/doi/full/10.10…
And maybe we can’t deliver on that first hope. But the others? Maybe endless possibilities for good outcomes! But we never know unless we ask.
And any time a procedurenis being considered, please remember Goals Before Holes. H/t @DanielMahoneyMD
Now we’re getting somewhere. Once we know their hopes, values, priorities, we combine that with the medical situation and can offer a recommendation for a path, or paths, forward. And that will bring us to shared decision making. Thoughts?
