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Goals of Care Designation Preparation

Dear Doctor,

I, , participated in the Plan Well Guide website on and wish to discuss or review with you my goals of care if I become seriously ill. By serious illness, I understand it to be a major medical problem where there is a possibility that I may die but there is also a possibility that I may get better. I understand that you can not predict the outcome, that I am making decisions today without knowing if I will recover or if I will die. I understand that we are not planning my terminal or end of life care; but rather, what to do in the event of a serious illness. I worked through one or more ‘values clarification tools’ that helped me think about and clarify what is important to me. I understand that some of these values compete with each other or that there are trade-offs. From my point of view, when considering treatments when I am seriously ill, the answers to the following questions show what is most important to me:

1.

On a scale of 1-7, select the number to best describe how important the following is to you:

I want medical treatments that focus on prolonging my life
Equally important
I want medical treatments that focus on maintaining the quality of my remaining life
2.

On a scale of 1-7, select the number to describe how important the following is to you when thinking about medical treatments:

I want doctors to do everything possible, including the use of machines, to keep me alive for as long as possible
Equally important
I would want a natural death without being attached to machines
Focus on maintaining the quality of my remaining life
 7
Your choices on the values scale will not make sense to the doctors (grey cells). Please go back and change your answers to the values questions so your answers fall into one of the white cells.
5. Medical Care
6. Comfort Measures
6
1. Equally
important 		5
3. Short-term trial of ICU Care including CPR
4. Short-term trial of ICU Care but no CPR
5. Medical Care
4
3
1. Full ICU Care including CPR
2. Full ICU Care but no CPR
Your choices on the values scale will not make sense to the doctors (grey cells). Please go back and change your answers to the values questions so your answers fall into one of the white cells.
2
Focus on prolonging my life
 1 1 2 3 4 5 6 7
I want doctors to do everything possible, including the use of machines, to keep me alive for as long as possible.
Equally important
2.
I would want a natural death without being attached to machines.
 

I chose these answers because:

3.

On a scale of 1-7, select the number to best describe how willing you are to accept the risks of ICU treatments/resuscitation:

Very willing
 
Not willing at all
4.

On a scale of 1-7, select the number to describe how willing you are to accept a reduced ability to look after yourself or a lower quality of life following recovery from an ICU stay:

Very willing
 
Not willing at all
Not willing at all
 7
Your choices on the values scale will not make sense to the doctors (grey cells). Please go back and change your answers to the values questions so your answers fall into one of the white cells.
5. Medical Care
6. Comfort Measures
6
3. Equally
important 		5
3. Short-term trial of ICU Care including CPR
4. Short-term trial of ICU Care but no CPR
5. Medical Care
4
3
1. Full ICU Care including CPR
2. Full ICU Care but no CPR
Your choices on the values scale will not make sense to the doctors (grey cells). Please go back and change your answers to the values questions so your answers fall into one of the white cells.
2
Very willing
 1 1 2 3 4 5 6 7
Very willing
Equally important
4.
Not willing at all
 

I chose these answers because:

I read information on the website about ICU, Medical Care and Comfort Care and took the Quick Quiz.

I watched a 7 min CPR Video Decision Aid* that describes the process of CPR, discusses treatment options and outcomes and helps clarify what is best for different patient groups.

After reviewing the information on the Plan Well website, I have the following preferences:

At this point in time, if life supports were needed to keep me alive, I prefer:

  • 1. Use machines and all possible measures including admission to ICU and resuscitation (CPR) with a focus on keeping me alive at all costs.
  • 2. Use machines and all possible measures including admission to ICU with a focus on keeping me alive but if my heart stops, no resuscitation (CPR).
  • 3. Use machines and all possible measures including admission to ICU and CPR only in the short term to see if I will get better but if the illness is prolonged, change focus to comfort measures only. If my heart stops, no further resuscitation (CPR).
  • 4. Use machines and all possible measures including admission to ICU (but no CPR) only in the short term to see if I will get better but if the illness is prolonged, change focus to comfort measures only. If my heart stops, no resuscitation (CPR).
  • 5. Use full medical care to prolong my life but if my heart or my breathing stops, no resuscitation (CPR) or breathing machines.
  • 6. Use comfort measures only with a focus on improving my quality of life and comfort. Allow natural death and no artificial prolongation of life and no resuscitation (CPR).
  • 7. Unsure.

* Please note the CPR video decision aid was not watched if patient was not interested in CPR (only if it was preferred or being considered)

Health states that are 'worse than death':

Congratulations ! Here is your Dear Doctor letter. Now, you can save it, download it, print it and share it with your health care team, family and friends. Make sure you share it with your Substitute Decision Maker, the person who would speak for you if you couldn’t speak for yourself. Remember, you are not making medical decisions today – you are thinking about what would be important to you (or someone else) during a serious illness. Your answers will help your health care team and your family make decisions for you if you were too ill to speak for yourself.

[sm-dear-dr]