Goals of patient care: Overview and resuscitation status
This page is to be completed by senior medical staff only. It is a medical care plan and is the responsibility of the leading paediatrician in charge of the child’s care. The tool is intended to promote discussion and shared decision-making with the child/caregiver(s). There is no requirement for the child/caregiver(s) to sign it.
It is not appropriate to hand this page to the caregiver for unilateral completion.
Medical staff should reflect on the individual child and their condition prior to engaging the family in discussion regarding limitation of medical intervention. If other clinicians are involved in the child’s care, it may be appropriate to meet to discuss goals of care to ensure full understanding of the child’s condition. This will guide a thoughtful conversation tailored to the child and their family. Some questions to consider:
What is the primary goal of care for this child – cure? Life prolongation? Comfort?
What are the prospects, with and without treatment, of return to a ‘normal’ life?
For any potential intervention, what is the probability of success? What are the potential burdens on the child of each intervention?
Is there consideration to forgo some treatments in order to maximise quality of life?
In summary, how can this child and family be benefited by medical care, and how can harm and suffering be avoided?[1]
Medical staff should be prepared for questions regarding the above issues, and should try to be as truthful and specific as possible. It is appropriate for medical staff to give their professional opinion/advice regarding the provision of medical interventions to the child. It may be appropriate for them to ‘own’ the resuscitation decision, if this is requested by the caregivers.
It is never appropriate to raise cost or resources as a reason for limiting care.
It may take several meetings to come to an agreement about goals of patient care. Discussions should be documented on page 3 of this tool.
If there is a disagreement between medical staff and family regarding resuscitation status, all measures should be taken to understand the specifics and reasons for the disagreement. A second opinion may be warranted, as may escalating the discussion to a more senior medical professional or to the Ethics department.
If there is urgency regarding decision-making coupled with insurmountable disagreement, it may be necessary to contact the legal department. This should always be a last resort, after all avenues for reaching an agreement have been exhausted.
1. Baker, J.N., et al., Integration of Palliative Care Principles into the Ongoing Care of Children with Cancer: Individualized Care Planning and Coordination. Pediatr Clin North Am, 2008. 55(1): p. 223-xii.