Goals of care
Formal Definition
A structured conversation between clinicians, patients, and family members to clarify the patient's values, beliefs, and treatment preferences, particularly regarding life-sustaining interventions, resuscitation, and acceptable functional outcomes; the outcome informs code status, advance directives, and overall care planning.
How It's Used on the Ward
"GOC conversation" or "we need to have a goals of care discussion" — the critical communication skill of aligning medical interventions with what the patient actually wants.
Example
""87-year-old with end-stage dementia and recurrent aspiration pneumonias: family conference to have a goals of care conversation. Framing: what did he value before the dementia? What would he say about being resuscitated, intubated, or tube-fed? Goal is to align care with his personhood, not just his biology.""
Clinical Context
Key communication skills: "What is your understanding of the illness?" → "What are you hoping for?" → "If things got worse, what matters most to you?" REMAP framework: Reframe the situation, Expect emotion, Map values, Align with values, Plan medical care accordingly. Document outcomes: advance directive, POLST/MOLST form, code status order. Distinguish: patient wishes (what they want) from best interests (what we think is best) — patient wishes take precedence. Substitute decision-makers: healthcare proxy, durable power of attorney for healthcare. Goals of care ≠ do not resuscitate — a patient can have a full code AND want comfort-focused care in other respects.