Whatever goals our patients set for themselves must be their goals and they must make them with as much information as they need. An Advance Directive, DNR (Do Not Resuscitate), or POLST (Physician Order for Life Sustaining Treatment) are important legal documents and the clinical team must be aware of these when managing care. But, of utmost importance are the patients’ goals. These are the goals that only they can determine. These are the precious moments in their life that are not our call. These are the goals that change as life changes. The goals that may move from wishes for years of life to the hope of one more holiday, a wedding, a birthday, a month, a week, a day. These are the reasons we must learn to talk to our patients about the end of their life.
Atul Gawande and his Ariadne Labs have developed a “Serious Illness Conversation Guide” to facilitate the discussion:
- What is your understanding of your current medical condition?
- How much information would you like now about your illness and its probable outcome?
- If your health situation worsens, what are your most important goals?
- What are your biggest fears and worries about the future?
- What abilities are so critical to your life that you can’t imagine living without them?
- If you become sicker, how much are you willing to go through for the possibility of gaining more time?
- How much does your family know about your priorities and wishes?