Goal Setting in Palliative Care at the End of Life

GOAL SETTING IN PALLIATIVE CARE AT THE END OF LIFE

As the treatment goals begin to shift in the direction of comfort care over aggressive disease-focused treatment, symptom relief and patient/family-defined quality of life assume greater promi-nence in treatment decision making. Patient, family, and clini-cians may all be accustomed to an almost automatic tendency to pursue exhaustive diagnostic testing to locate and treat the source of the patient’s illness or symptoms. Each decision to withdraw treatment or discontinue diagnostic testing will be an extremely emotional one for the patient and family. They may fear that the support from health care providers on which they have come to rely will be withdrawn along with the treatment.

Throughout the course of the illness, and especially as the pa-tient’s functional status and symptoms indicate approaching death, clinicians need to assist the patient and family to weigh the benefits of continued diagnostic testing and disease-focused med-ical treatment against the burdens of those activities. Patients and their families may be extremely reluctant to forego monitoring that has become routine throughout the illness (such as blood testing, x-rays) but that may contribute little to a primary focus on comfort. Likewise, health care providers from other disciplines may have difficulty discontinuing such diagnostic testing or med-ical treatment. The nurse should collaborate with other members of the interdisciplinary team to share assessment findings and de-velop a coordinated plan of care (Fig. 17-1). In addition, the nurse may assist the patient and family to clarify their goals, ex-pected outcomes, and values as they consider treatment options  (Chart 17-5). The nurse needs to work with interdisciplinary colleagues to ensure that the patient and family are referred for continuing psychosocial support, symptom management, and assistance with other care-related challenges (eg, arranging for home care or hospice support, referrals for financial assistance).