So if as a consumer, as a patient, you hear the word Goals of Care,
it should be about goals and values and things that you want to happen to you
in terms of the kind of life that you want to live. You know, we need to be able to tailor make the
medical intervention and the medical treatment to a particular value or goal or lifestyle that you
want. You are the most important person in deciding your Goals of Care and therefore,
our agreed Goals of Care for your treatment. So, a Goals of Care plan, completion of a document,
is what we call a clinical care plan. It's a hospital-based document
that frames and outlines the treatment decisions we're taking in relation to this particular
episode of care, the time you're in hospital. An advanced care plan is something the patient does,
often with assistance, to write down what their wishes are, what treatments they
would consider and how they would like to be cared for. It's signed by the patient,
and it's a declaration of their wishes. It should pre-date hospital admissions wherever possible,
and we don't usually prepare advance care plans with patients during a hospital
occasion of service, cause often they're unwell, it's hard for them to make clear decisions. We
would always encourage people to plan ahead. So the biggest benefit for you in having a Goals
of Care discussion is firstly, confidence that the clinicians understand your wishes and preferences,
trust in the clinician that the treatment you will receive will be consistent with those wishes
and together we can pursue the best outcome for you.
One of the key reasons for having a Goals of Care conversation is the possibility
exists that you may lose the ability to make decisions for yourself if you become sick.
What we're trying to set is what level of treatment we agree is appropriate,
is of value to you, we won't offer treatments that won't help, and is consistent with your wishes.
So when we have a conversation about goals of care, we'll often start about trying to
understand how you function at the moment and what is currently important to you in your
life and often people will then talk about what's not a good quality of life for them,
so at what point is it not worth those things and that enables us to then have a shared conversation
about the things that may happen to you, that are likely happen, and therefore try and make some
decisions about what treatments are appropriate and what treatments won't help get you back to
that quality of life that you can define. This has to be a shared decision, I don't think it
should ever be something that someone leaves the hospital and feels like they've made alone.
First level of treatment is basically offering all available treatments, including intensive care and
including very advanced treatments like dialysis, possibly what we call ECMO which is an external
oxygen support system or other forms of very advanced therapy. The next level of treatment
is intensive treatment, with a treatment ceiling. In other words, we make some choices
about treatments you would not want and we don't think we should offer you
cause they won't be beneficial or you don't wish to tolerate them because they're uncomfortable,
can be distressing and can be prolonged. The third level of treatment is ward level care,
optimised to give you the best chance of a good outcome but removes the intensive treatments,
and we agree specifically on which treatments can be provided because there is a limit to the kind
of treatments that can be provided at ward level. And then finally, there is optimum comfort care,
often as part of a care program to manage somebody who is dying or who has chosen not to be
treated any longer because they don't wish to be treated any further which is always their choice.
If you put something in a Goals of Care document and you change your mind, we will change the Goals
of Care document. The document can be revised at any time and is always contemporary. So we've been
doing a lot of work to make the documents more accessible. It is now able to be seen by anybody
working in the hospital with health professional status, and so it's available in all clinical
environments during a hospital admission. We are though involved at the moment in a project,
with the patient's permission, to include their Goals of Care record in the Australian My Health
Record so it can be viewed by clinicians outside the hospital. Having that information available,
what you thought at a particular time, is valuable. So we look forward to that option,
sharing the information more widely. What that also means, is it's really important, and one
of the things I would always ask you, is who is the person who you want to speak on your behalf
when you can't speak for yourself. Unfortunately sometimes, people can't speak for themselves,
and that's where that prior discussion enables family members to make decisions that they know
are right then they think are right and that reduces stress in this situation. When I hear
from a family member, mum said she never wanted to be in a nursing home, she never wanted to be
in this situation, it allows us to make a much more informed decision than I never talked about
this with mum I don't know what she would want, and the burden on family members is then reduced
and that's really important when you're making these really big decisions about family members.
It's really important we talk to our relatives about what is the most important thing in our
lives and often people will describe someone they know or something that happened to someone else
and that's a really good starter conversation often of what would you want in that situation
that gives your family the opportunity to give them much more information in the future
if this discussion ever has to happen and I think we can never talk about it too much but it is
something that some people find quite confronting to talk about so often despite it being
something that we should all talk about, often it's not discussed until there is a health crisis.
We use a Goals of Care to build a picture of a family, build a picture of a child,
understand what's important to them and then share the decision-making
so we're kind of doing that planning ahead and then sharing the decision-making about
when we face deterioration, what would be most appropriate. The information is shared across
the state because what we hope is that we know that children present to different hospitals
and it prevents the families from having to start from scratch should something occur and
the teams need to react and follow the Goals of Care plan. The Goals of Care acts as a guide
to health professionals but they would always check back in with the family to ensure that
the approach is still appropriate and meeting the families wishes.
It's extremely important that patients know what the health system can offer them,
know that their wishes and their goals are represented and that people have heard them
and that we're going to try and deliver that as best as we can.