It’s Your Life: Finding The Right Healthcare Goal

Every person has the option of choosing the most appropriate healthcare for their individual situation.  Sometimes knowing when to say ‘enough’ to certain treatments without seemingly ‘giving up hope’ can be a great concern as well as a challenge; but one which can ultimately lead to a sense of relief. The following information will help explain important healthcare choices based on an understanding of ‘Goal Focused Care’.

 

 

What is Goal Focused Care?
This is care and treatment that is reasonable based on the type of disease and chance of being cured. When it is reasonable to expect a cure, then treatment is aggressive to reach this goal. When a cure is no longer possible, then goals and treatments vary depending on the disease process and the patient’s beliefs regarding quality of life.
Most people want to make healthcare choices that bring them the best quality of life possible. For many people, continuing everything medically available is the appropriate goal because there is hope that treatments and medicines will improve and benefit their current state of health; for example, a healthy adult with pneumonia takes antibiotics to get well.

For some people with a serious illness that cannot be cured, the goal and hope is to maintain present health with current drugs and treatments while saying ‘no’ to any major intervention such as surgery that potentially may bring more discomfort instead of adding to the present quality of life: for instance, an elderly patient with mild dementia and a history of stroke who chooses not to have a heart valve replacement since surgery increases the risk for another stroke and can worsen the dementia.

Still others approaching the end of life may prefer only those medicines or treatments that keep them comfortable, bringing hope that the end of life will come peacefully with little or no suffering.  Example: a patient with advanced cancer already spread to other body organs wants everything that offers comfort but nothing else.

 

When to consider alternate healthcare goals:

• If you have a Life Limiting Disease (LLD): these are diseases which will cause you to eventually die unless some other problem occurs first. Examples are Alzheimer’s, many cancers, congestive heart failure, kidney failure, end-stage lung disease (emphysema), AIDS, Lou Gehrig’s Disease.

• Chronic, incurable pain/suffering from whatever cause.

• If you seem to be in what’s been termed “The Downward Spiral”: the “Spiral” refers usually to the last year or two of life, when your chronic problems (often from one of the LLD’s above) are worsening and lead to more frequent admissions to hospital and visits to doctors, and you start requiring more assistance in your ADL’s (Activities of Daily Living – dressing, toileting, feeding, bathing, walking). You go from being relatively well and independent to more and more dependent.

• Generally feeling “tired and worn out”, despite medications, etc: this usually goes hand-in-hand with any/all the above. 

• Tired of taking pills or treatments: the average senior takes over seven (7) drugs daily and see multiple doctors regularly. Evidence is mounting that the more drugs seniors take, the less quality of life they have, and their lifespan is actually shortened (see information article Polypharmacy). In addition, new evidence—now even in the public press—shows there is little benefit in taking most vitamins and supplements.

• Just wanting a more ‘natural’ approach to life:  some people reach a point where they are ready to decide to “let go and let God”, accept each day as a gift, take one day at a time (as in the Serenity Prayer), and not worry about the future (as people often did before all the technology and drugs).



What are the healthcare goal choices? (See attached worksheet)

• Continue everything as is, for now, but I can change my mind if my circumstances change.

• Continue all my current drugs and medical treatments but no surgery.

• Stop only those drugs which need a long time (more than a year, such as cholesterol reducing ones) to be beneficial.

• Stopping all drugs/treatments—including antibiotics—except those to keep me free from pain or other uncomfortable symptoms.


Every person has the right to make decisions about the kind of care they receive if they become sick. It is also the responsibility of each individual to talk about these decisions with their doctor. An Advance Directive can help make these important healthcare decisions known to others.
Understanding the difference in healthcare goals can bring quality and hope to any stage of life.



Goal Focused Care -  Patient/Family worksheet

(options for patients/families to consider, especially when completing an Advance Directive [Living Will], based on their goals, and after reading the handouts “Allowing for Natural Death – Myth & Reality” and “Goal Focused Care:  how to choose the most appropriate healthcare while in hospital”, as well as other handouts)


Option A. Longevity - do everything medically possible to live, continue all medicines, treatments, lab tests, procedures.

FULL CODE (CPR): Chest compressions and shocking. Mouth to mouth breathing. A tube for a breathing machine is placed


Option B. Comfort-Continue treatments as ordered, control symptoms and treat discomfort aggressively, but NO CPR.

A.N.D. (Allow Natural Death):     If no pulse, no chest compressions If no breathing, no mouth to mouth No shocking or breathing machine

Option C. Comfort measures ONLY: Do everything to help control symptoms and treat discomfort aggressively. Stop treatments and medicines that do not promote comfort (for example, cholesterol-lowering drugs).

A.N.D. (Allow Natural Death):     If no pulse, no chest compressions If no breathing, no mouth to mouth No shocking or breathing machine

PLUS: List any medicines or treatments that may not be necessary if goal of care is ‘comfort
measures only’. Discuss the benefit of continuing or stopping any of these with your
physician so orders can be written to follow your wishes.

Medicine(s)

Lab tests______________________________________________________

Xray/other procedures___________________________________________

IV fluids/feeding tubes____________________________________________