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Review Article: Goals of Care Toward the End of Life: A Structured Literature Review

Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Carver College of Medicine, Program in Bioethics and Humanities, University of Iowa Carver College of Medicine, Center for Research in the Implementation of Innovative Strategies in Practice, Iowa City VA Medical Center, lauris-kaldjian{at}uiowa.edu

Ann E. Curtis, MD

Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Carver College of Medicine, Center for Research in the Implementation of Innovative Strategies in Practice, Iowa City VA Medical Center

Laura A. Shinkunas, BA

Program in Bioethics and Humanities, University of Iowa Carver College of Medicine

Katrina T. Cannon, MD

Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Carver College of Medicine, Center for Research in the Implementation of Innovative Strategies in Practice, Iowa City VA Medical Center

Goals of care are often mentioned as an important component of end-of-life discussions, but there are diverse assessments regarding the type and number of goals that should be considered. To address this lack of consensus, we searched MEDLINE (1967—2007) for relevant articles and identified the number, phrasing, and type of goals they addressed. An iterative process of categorization resulted in a list of 6 practical, comprehensive goals: (1) be cured, (2) live longer, (3) improve or maintain function/quality of life/ independence, (4) be comfortable, (5) achieve life goals, and (6) provide support for family/caregiver. These goals can be used to articulate goal-oriented frameworks to guide decision making toward the end of life and thereby harmonize patients' treatment choices with their values and medical conditions.

Key Words: goals of care • end-of-life care • palliative care • clinician—patient communication • quality of care • clinical ethics • clinical decision making • patient-centered care

American Journal of Hospice and Palliative Medicine®, Vol. 25, No. 6, 501-511 (2009)
DOI: 10.1177/1049909108328256


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