Goals of Care

Prior to the creation of the GOC form, there were several forms and approaches to having ‘Do not Resuscitate' (DNR) discussions with patients. There was no official training and the process was inconsistent throughout the province. Nova Scotia Health recognized this discrepancy and worked to create a standardized approach to documenting and having these discussions. 

The previous ‘DNR/Allow Natural Death’ forms have been removed from the health system and replaced with the ‘Patient-centered Priorities and Goals of Care’ form. This form encompasses a holistic approach to determining a patient’s goals for their care including what ‘level of intervention' (LOI) aligns with their wishes in a life-threatening situation.

Having one standard form and approach enables a common language and understanding of the LOI across our health care system, and supports quality and continuity of care.

A Nova Scotia Health Goals of Care and Levels of Intervention Policy has been created to standardize the approach to discussing, determining, and documenting GOC and LOI decisions on the Patient-centered Priorities and Goals of Care form. This policy applies to most responsible health care providers/authorized prescribers, and authorized and unauthorized health care providers. Review the policy: 

A Nova Scotia Health Goals of Care and Levels of Intervention Care Directive provides the authority and conditions under which the RN and LPN may discuss and document GOC and LOI decisions with the patient/substitute decision maker (SDM), and initiate and document on the Patient-centered Priorities and Goals of Care form. 

Completing the GOC form

This 5-minute video reviews the different elements of the Patient-centered Priorities and Goals of Care form:

Goals of Care (GOC) discussions occur in the context of a serious illness or condition where there are current or future treatment or care decisions that need to be made. As you go through the Goals of Care form, the following are some key areas to consider:
 

• Is this the first goals of care discussion for this patient, or are you revisiting a previous discussion? If so, indicate this on the form.
• What is the context for this discussion?
• Confirm the patient’s capacity to participate in the discussion and that the right people are involved in the decision making.
  • If the patient does not have capacity, you will need to speak with the person who is authorized to make decisions on their behalf, for example a Delegate or substitute decision-maker (SDM) as outlined in the Nova Scotia Personal Directives Act.
• Goals of Care Supplementary Information and Patient Priorities
  • To the best extent possible, document the pertinent health conditions, recent changes in status (page 2), their views on quality of life and preferences (page 1).
• Level of Intervention
  • Once you have reviewed and discussed the information above, it is important to confirm and document the level of intervention a patient would want/receive should their health decline and specific interventions be an option. This discussion should include provider recommendations about which treatments would be likely to help the patient achieve their goals of care.
• What are the other important considerations for the patient? Document any other details that may help other clinicians interpret the level of intervention or understand the context of the decisions made.