Unwanted or unwarranted treatments at the end of life can contribute to suffering for patients, families and whānau, moral distress for clinicians, and unnecessary expenditure for the health system.
Documented goals of care should represent the outcome of a shared decision-making process between the patient and the clinical team. At a minimum, the overall direction for an episode of care (eg, curative, restorative, improving quality of life or comfort whilst dying) and any agreed limitations on medical treatment need to be identified.
Effective communication is necessary to elicit patients’ values and preferences for care and ensure informed choices can be made about complex medical treatment options. Ideally these conversations occur prior to episodes of acute deterioration without the pressures of an evolving and emergent clinical crisis. Read the case for change (302kb, PDF).
We held national workshops in late 2017 and early 2018 with clinicians, consumers and organisations. These workshops reinforced the range of components and key principles associated with successful goals of care conversations, and that our approach to improvement needs to be multi-faceted to reflect this. In late 2018 we established a multidisciplinary working group to develop a national approach to determining, communicating and documenting shared goals of care. The group has met several times to develop draft principles and a draft shared goals of care form for testing.
Summary of the draft shared goals of care principles
Shared goals of care discussions need to be underpinned by Te Tiriti of Waitangi. Patients, whānau and clinicians should be supported before, during and after these discussions. Health care providers need to ensure that governance systems, infrastructure and organisational culture encourage and prioritise these discussions.
Shared goals of care discussions should be held as early in the admission as possible with all adult inpatients. These discussions need to be led by the appropriate clinician and may be single or various discussions. The environment should be appropriate. The discussion and decisions must be documented in a clearly identifiable and accessible clinical form.
MidCentral and Waitematā district health boards tested the draft principles and form between October 2019 and March 2020. They used the draft principles to prepare for testing and the draft form has been informed by their testing. The testing was put on hold and we are now reviewing further testing requirements.
As part of our response to COVID-19, we have made shared goals of care forms, along with related factsheets, available for hospitals and aged residential care facilities on the talkingCOVID webpages.
Please let us know if you use the form(s) and if you require any assistance (we are available by phone or Zoom, or you can email us at firstname.lastname@example.org).