Making the Most of Goals-of-Care Conversations

At their most basic, goals-of-care conversations are a necessary tool in gathering information about our patient’s healthcare wishes. But when they’re done right, they tell us so much more and open up the door to trust and true communication.

When speaking to patients about their goals of care, remember to listen more than you speak. You may be the healthcare expert, but the patient is the expert on themselves. Empower them to share their story in their own way. You may be the first person to do this in a very long time.

Important Goals-of-Care Questions to Ask

The best way to learn what the patient knows about their current medical condition is to ask them. The goal is to learn not just what they know, but also what their level of understanding is about their diagnosis. Simply parroting back medical terminology doesn’t mean they actually understand it, so dig deeper.

Questions that can help include:

• What has your doctor told you?
• Tell me about quality of life according to you.

These open-ended questions help you start to understand what scares the patient and what they hold sacred. But don’t stop there, continue asking questions.

Additional questions to ask include:

• If they refuse our care, ask why. What are they afraid of?
• If doing more testing, what will they do with the results?
• If pursuing more treatment, what will the likely outcome be?

The patient has the right to pursue additional testing and treatment, and we need to respect and support their decision. Asking the tough questions about what they expect from the additional testing and treatment allows them to consider all of their options and how it fits in with their goals of care. We should never make the decision for them.

A terminal diagnosis is painful for the patient and their family. Sit with them in their pain. Listen to them. Support them through it, and don’t rush out of it even if it makes you uncomfortable.

Gathering Details in Goals of Care Conversations

Cover the details of the patient’s healthcare wishes as appropriate with questions like the following:

• Would they like CPR performed or would they prefer a natural death if their heart stops beating?
• Do they want life-sustaining treatments like a feeding tube or ventilator?
• Do they want to go back to the hospital?
• Who will make the decisions in an emergency?
• Where do they want to receive care?

Patients are still eligible to receive hospice care if they are still a full code, considering a transplant, wish to return to the hospital, are considering possible chemotherapy, or if they are receiving IV fluids, antibiotics or have had a tracheotomy. While some of these choices may require leaving hospice at the time they pursue additional treatment, they are absolutely entitled to receive hospice care in the meantime and can return to hospice care in the future if the treatments are not successful.

Ultimately, goals-of-care conversations aren’t about us. They’re about partnering with our patients. They’re about understanding their values, perspectives, fears, and desires. They’re about getting people the care they want and need.

To learn more about Crossroads Hospice & Palliative Care’s services and how we support terminally ill patients, please call 1-888-564-3405.

Sherri Bickley, CSW, M.Th.
VP of Patient Support Services
Crossroads Hospice & Palliative Care

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