Goals of Care

Planning for peace of mind.

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Making medical decisions to support a person living with dementia can sometimes feel like reaching a busy intersection with many forks in the road.  How can we choose the direction that best reflects the wishes and goals of the person with dementia?

As a full-time emergency room (ER) physician I have observed that establishing goals of care helps care partners, families, and people living with dementia to better understand care choices and to feel confident when making medical decisions on behalf of a person with dementia.

Planning for peace of mind begins with understanding which of the three fundamental goals of medical care will best honor the wishes of the person living with dementia.

Goals of Care

1) Full Treatment - Primary goal is to stay alive. All medical interventions available to treat new or pre-existing conditions are requested. Care that is focused on keeping someone alive is OK.

2) Some but Not All - Primary goal is to protect and maintain quality of life. Medical interventions are chosen on a case-by-case basis depending on the person's recent quality of life. Care that is focused on prolonging life may or may not be OK depending on the situation and how the person's quality of life would be affected with or without it.

When a person no longer wants CPR (cardiopulmonary resuscitation) they will be in this goal of care group (or comfort care) and not in Full Treatment.

3) Comfort - Primary goal is to prevent suffering and provide comfort. Any care intervention, including medications, procedures, surgery, testing, trips to ER or stays in hospital, should have the underlying intention to first provide comfort. The person should not receive care that is meant to keep them alive as the main reason for care.

Although conversations about medical care can be uncomfortable, planning goals of care well ahead of a pressure-filled visit to the ER will offer you considerable peace of mind should a life changing decision be required.

Photo: Canva

Start a Conversation

Key questions to discuss or think through when planning goals of care:

  • What fundamental values has the person with dementia held throughout their life?
  • What does quality of life mean to the person with dementia?
  • What is their current quality of life?
  • What level of medical screening or intervention is acceptable?
  • When will goals of care be reassessed?

Wherever possible, people with dementia should be included in conversations to establish goals of care. Decisions about goals of care should be shared among family members so they are not a surprise at the time of a medical event.

While conversations about medical goals of care can feel heavy, the peace of mind and confidence these conversations can provide is well worth the effort.

GET MORE INFORMATION

More from Dr. Lamb from the Live Well article archive: Ten Tips to Make an ER Visit Less Stressful.

ABOUT THE AUTHOR

Dr. Brittany Lamb graduated from medical school at the Florida State University College of Medicine and was residency trained at The University of Alabama at Birmingham. She is a board-certified emergency medicine attending physician with over 12 years of health care experience, more than eight years in the ER.

Dr. Lamb supports care partners to become confident medical decision makers through her free Facebook Community and her online course – Make Your Plan with Dr. Lamb. Learn more at BLambMD.com.

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