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Goals of Care Designations Conversations Matter: Planning for your future healthcare

What is a Goals of Care Designation Order (GCD)?

• A medical order that describes the general focus of your care.

• Helps the healthcare team match your unique values and preferences to care that is most appropriate for you and your healthcare condition.

• Written by a doctor or nurse practitioner.

• Ideally created after conversation between you and members of the healthcare team.

• Recognized in all care settings in Alberta.

• Changes as your health changes; any doctor can update your GCD order.

Deciding your most appropriate GCD is a process. Factors considered:

Your doctor’s recommendations

Your medical problems

Your values and wishes

Questions to consider:

• Do I fully understand my healthcare conditions and prognosis?

• What are my treatment risks and benefits?

• Are life saving measures like cardio-pulmonary resuscitation (CPR) likely to benefit me?

• What would I be willing to go through for more time? Is quality of life more important than living longer?

• What treatments are available where I live so I don’t have to go to the hospital?

Who needs a GCD Order?

It is important for individuals to have a GCD order when full resuscitative care is not what they want or is not medically appropriate. Without a GCD order stating otherwise, full resuscitative care is provided when someone’s heart stops beating or they stop breathing.

To find out if you need a GCD order talk to your healthcare provider.

They can help determine if you need a GCD order.

If you have a GCD order it can and should change as your health changes. Talk with your healthcare team if:

• your current health situation, values and wishes have changed

• you are not sure what your GCD order includes

• you are not comfortable with your current GCD order

Three general approaches to care

  • Medical Care
  • Comfort Care
  • Resuscitative Care

What treatments will help me live the way I want and where I want?

If I get sicker are there medical treatments that I feel strongly about either having or not having?

With this illness what can I expect my life to look like in 1 month? 6 months? 1 year?

Medical Care

In this approach to care, a person is expected to benefit from and values any appropriate medical tests and treatments that can be offered, excluding intensive care (ICU) and resuscitative care. Locations for care (e.g., at home, hospital, and care facility) are considered depending on what is medically appropriate and in keeping with the patient’s wishes and values.

M1 means using any appropriate medical and surgical treatments, including going to the hospital, to try to “fix the fixables” with a focus to live as long as possible and maintain your desired quality of life. The team will not use pushing on the chest (“CPR”), a breathing machine (“ventilator”) or intensive care unit (“ICU”). M1 communicates that there are limits to what resuscitation and life support can achieve for you.

When is M1 appropriate?

M1 is appropriate in situations when a person is unlikely to survive an attempted resuscitation, or when resuscitation is unlikely to leave the person in a state of living they value.

M2 means you will be treated at home or a care facility and avoid hospital admission. Medical treatments available in the home or a care facility will be used to try to “fix the fixables”. If you don’t respond to home-based treatments, your healthcare team will talk to you about re‑evaluating your wishes and goals, which may include changing your focus of care to comfort care.

When is M2 appropriate?

M2 is for people who are frail or chronically ill and their health is more likely to worsen rather than improve with going to the hospital. It is also appropriate when a person no longer wants the kind of treatments available in the hospital or when hospitalization is unlikely to leave the person in a state of living that they value.

Comfort Care

In this approach to care, the aim of medical tests and treatments is to manage symptoms of the disease and maintain function when cure or control of an underlying condition is no longer possible or desired. Transfer to a hospital may occur in order to better understand or control symptoms.

C1 means that the focus of care is to provide comfort, with symptom control and using medical treatments that maximize your quality of life rather than focusing on your length of life.

When is C1 appropriate?

C1 is appropriate in situations where a person is very frail or living with serious illness and is unlikely to respond to medical treatments aimed at prolonging life. It is appropriate when the person wants to focus on their quality of life more than their length of life.

C2 means that you are in the final hours or days of life and all treatments are focused on your comfort and support of those close to you.

When is C2 appropriate?

C2 is only appropriate when a person is imminently dying (i.e., final hours or days) and treatments can no longer prolong life.

Resuscitative Care

In this approach to care, a person is expected to benefit from any appropriate medical tests and treatments that can be offered and may include intensive care (ICU) and resuscitation.

R1 means that any appropriate medical and surgical treatments including pushing on the chest (“CPR”) a breathing machine (“ventilator”) and intensive care unit (“ICU”) will be used to try to prolong your life during a critical illness.

When is R1 appropriate?

R1 is most appropriate in situations where a person is likely to recover from an illness and return to how they were before. The person wants this attempt made to prolong life, even if it may leave them with permanent changes to their health and abilities.

R2 means that any appropriate medical and surgical treatments including a stay in the intensive care unit care and breathing machine (“ventilator”) will be used to try to prolong your life during critical illness. The team will not use pushing on the chest, referred to as resuscitation. This means “No CPR.”

When is R2 appropriate?

R2 is appropriate in situations where a person’s heart is unlikely to restart if it stops but they have an illness that might benefit from a breathing machine and intensive care. R2 is also appropriate when CPR is unlikely to leave a person in a state of living that they value.

R3 means that any appropriate medical and surgical treatments including a stay in the intensive care unit will be used to try to prolong your life. The team will not use pushing on the chest “No CPR” nor use a breathing machine “No ventilator.”

When is R3 appropriate?

R3 is appropriate in situations where resuscitation and a breathing machine are unlikely to be able to prolong a person’s life but they have an illness that might respond to intensive care. R3 is also appropriate when use of CPR and a ventilator is unlikely to leave a person in a state of living that they value.

Your Green Sleeve

A Green Sleeve is a plastic pocket that holds your advance care planning forms. Think of it like a medical passport.

• There are two ways to get a Green Sleeve: from your healthcare provider or you can order one online.

• It is your property. When you are at home, keep your Green Sleeve on or near your fridge.

• Healthcare providers in all settings may ask if you have a Green Sleeve.

• If you go to the hospital or a healthcare appointment take your Green Sleeve with you.

Be sure it comes home with you.

For more information: www.ahs.ca and search advance care planning

To order a Green Sleeve: myhealth.alberta.ca and search Green Sleeve

Advance Care Planning Checklist

  1. I have thought about my values and wishes and healthcare goals.
  2. I have thought about organ and tissue donation and I have communicated my wishes to my family and registered my donation intent on Alberta’s Organ and Tissue Donation Registry.
  3. I have asked my healthcare provider(s) about my current health and what future healthcare decisions I might need to make.
  4. I have completed a personal directive and named my decision‑maker (agent).
  5. I have spoken to my decision-maker (agent) about my wishes and given him or her a copy of my personal directive.
  6. I have discussed my healthcare treatment wishes with those closest to me.
  7. My doctors and I have discussed the Goals of Care Designation that best reflects my current situation.
  8. I have a Green Sleeve to hold my documents (including my personal directive and Goals of Care Designation Order) and I have placed it on or near my fridge.
  9. Whenever I go to the hospital or a healthcare appointment, I will bring my Green Sleeve with me.

For more information, please contact your healthcare provider or visit: conversationsmatter.ca

For 24/7 nurse advice and general health information, call Health Link at 811.

If you need an interpreter just say the language you need.

Current as of: October 30, 2019

Author: Palliative and End of Life Care Team, Alberta Health Services.

This material is for information purposes only.  It should not be used in place of medical advice, instruction or treatment.  If you have questions, talk with your doctor or appropriate healthcare provider.









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