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Goals of Care

Aligning patient priorities to provide person- and family-centred care.

About Levels of Intervention (LOI)

The Level of Intervention (LOI) describes the scope of medical interventions that are anticipated to be helpful in achieving the patient’s goals of care. LOI encompasses more than code status and is determined only after a high-quality goals of care discussion about the patient’s priorities, health condition, and preferred location of care.

When determining a level of intervention, it is important to remember the GOC Form is not a step-by-step guide. Consideration must be given to your practice area. Every possible treatment option is not listed and the interventions need to be tailored specific to the patient.

Comfort Care

C2 (Comfort Care) Goals

  • Provide supportive care, symptom management and comfort measures within current location of care if possible.
  • Allow for natural death.
  • Patient-accepted transfer to emergency department to be decided in real time based on context and priorities.
  • No non-invasive positive pressure ventilation (NIPPV), intubation and/or vasopressors.

Resuscitation

  • No resuscitation in cardiac arrest.

C1 (Comfort Care) Goals

  • Provide supportive care, symptom management and comfort measures within current location of care if possible.
  • Allow for natural death.
  • Treatment which may prolong life to be decided in real time based on context and priorities.
  • Patient-accepted transfer to emergency department to be decided in real time based on context and priorities.
  • No non-invasive positive pressure ventilation (NIPPV), intubation and/or vasopressors.

Resuscitation

  • No resuscitation in cardiac arrest.

Selective Care

S2 (Selective Care) Goals

  • Provide medical treatment to cure or control symptoms and prolong life, excluding CPR. 
  • Allow for natural death.
  • Patient-accepted transfer to emergency department.
  • Non-invasive positive pressure ventilation (NIPPV) and/or vasopressors to be decided in real time, based on context and priorities.

Resuscitation

  • No resuscitation in cardiac arrest.

S1 (Selective Care) Goals

  • Provide medical treatment to cure or control symptoms and prolong life, excluding CPR. 
  • Allow for natural death.
  • Patient-accepted transfer to emergency department.
  • Provide care and treatment targeted to symptoms if possible.
  • Provide NIPPV and intubation (outside surgery) and/or vasopressors.

Resuscitation

  • No resuscitation in cardiac arrest.

Full Code

F (Full Code) Goals

  • Investigations, treatments and interventions should focus on cure or control of illness.
  • Prolonging life by all medically-effective means.
  • Provide treatment for reversible conditions.

Resuscitation

  • Full code/resuscitation (In the context of cardiac arrest, this could include chest compressions, electrical cardioversion, intubation, and assisted ventilation.)

Guidance to LOI Designations

Please use the colour-coded guide below to help differentiate the different Levels of Intervention:

 

Please use this conversation guide to assist in discussing the different Levels of Intervention with patients and families:

 

Patient-centred priorities and Goals of Care: Understanding the Levels of Intervention on the Goals of Care Form

Nova Scotia Health, 2022