Developing a Plan: Big Picture Goals

Imagine that you and your family are planning to go on a trip. Usually, you will decide on where you are headed before deciding on details like which road to take to get there. As obvious as this may seem, sometimes care decisions are discussed or even argued about without the involved people agreeing on a common destination. So we encourage you to discuss and clarify what we call "big picture" goals first.

So what type of big picture goals are there?

It may help to consider possible goals along a line or spectrum. At one end of the line the goal might be to cure someone or keep someone alive as long as possible (if cure is not possible). Of course everybody wants to be as comfortable as possible, but at this end of the spectrum there would be a willingness to give up some comfort for the goal of cure or life prolongation. At the other end of the line the goal might be to focus on keeping the person comfortable and enhancing his or her quality of life, but not to try to prolong life. Between these two extremes, there is a large gray area where a personal balance exists between life prolongation and an emphasis on comfort and quality of life. We cannot tell you what the “right” balance is for you and your loved-one. Patients and families with very similar illnesses medically may have a different balance and thus different goals.

Making such a decision regarding the goals of care can be very difficult for patients, families, and clinicians.

We encourage you to consider what you think might be best from your point of view, but also to listen to the opinions of others – both clinicians and other family members. Some things that may help you in this include considering:

  1. How certain is the diagnosis and the prognosis?
  2. How likely are possible therapies to result in cure or a significant prolongation of life? Are there other possible benefits to the therapies beyond this?
  3. How difficult are these therapies in terms of discomfort or stress? Does choosing a particular therapy or therapeutic approach restrict in some way access to something else that is highly desired? (For example, certain therapies can only be done in the hospital, thereby limiting care at home as an option.)
  4. What alternatives exist to therapies under consideration?
  5. How was the person’s health prior to the most recent illness - good health and good quality of life, or poor health with a decreased quality of life?
  6. Given what you know of your loved-one, what goal makes the most sense in terms of the way he or she has lived life and his or her values?


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