SECTIONS

Goals Of Care

OVERVIEW

Goals of Care is a standard process for documenting a patient’s values, wishes and goals in the context of medically appropriate treatment. It supports advanced care planning and encourages each patient to take an active role in their care.

These conversations are documented in the patient’s medical record as a legal part of their chart. This ensures the care team can understand and honour the patient’s preferences. Particularly if their condition changes or they’re unable to communicate their wishes.

Why Goals of Care?

Goals of Care is a patient-centered approach that ensures your values, wishes, and treatment goals are respected and considered throughout your care. These conversations are part of advance care planning and can happen at any stage of illness, not just at the end of life.

Goals of Care discussions help patients and families make informed decisions by clarifying options, priorities, and medically appropriate treatments. They support shared decision-making and reduce confusion during times of crisis or uncertainty.

Your choices are documented in your medical record as a legal part of your chart and will follow you across the healthcare system. This helps ensure consistency in how your care team understands and honours your preferences.

These conversations also help your care team understand what types of treatments you do or do not want.

RESOURCES AND INFORMATION

Designations

Goals of Care designations help ensure that the care you receive matches your wishes, values, and preferences. These designations are based on conversations between you, your healthcare provider, and, if needed, your Substitute Decision Maker (SDM).

Your designation is recorded in your medical record. This helps your care team understand what treatments you want in case of serious or emergency situations.

You may choose from the following:

R1: Full Resuscitation
You want all life-saving treatments, including CPR (cardiopulmonary resuscitation) and breathing support.

R2: Limited Resuscitation with Support
You do not want CPR, but you do want other treatments such as breathing support (for example, intubation or Intensive Care Unit care).

R3: No Resuscitation, No Life Support
You do not want CPR or life-support treatments such as breathing machines or Intensive Care Unit (ICU) care.

M - Medical Care without Resuscitation
You want medical treatments, but you do not wish to undergo resuscitation (ie, CPR or being put on life support).

C - Comfort-Focused Care Only:
You want care focused only on comfort and symptom relief. This means no life-saving treatments, but full attention to your comfort and quality of life.

Documents

Goals Of Care Brochure

Advance Care Planning Tracking Record

The Advance Care Tracking Record helps your healthcare team understand and document your care wishes. It is part of your health record and is updated regularly to reflect conversations you've had about your values, treatment preferences, and future care.

These discussions may happen over time and can involve any member of your care team.

Topics may include:

What to expect from your current treatment
Your values and how they affect your healthcare decisions
Life-saving treatments like dialysis, feeding tubes, or IV fluids
Options to help keep you comfortable
Supports available to you, such as social work or spiritual care
Any specific instructions about your future care goals - Goals of Care Designations

FAQ's

How will this impact my care?

Goals of Care is a communication tool between healthcare providers used to respect your values and wishes regarding the treatment you receive

Is this only for when I am in the Hospital?

Goals of Care follow you as a patient through all care settings and are part of your legal health record. Whether you are at home, in a long-term care facility, or in hospital, these decisions guide your care.

When will this conversation take place?

Conversations regarding Goals of Care take place as early as possible and are revisited throughout your care, especially if there are changes in your condition or preferences.

Who will have this conversation?

Any member of your healthcare team can begin this conversation with you. Your Most Responsible Health Practitioner will document your wishes using the Goals of Care form in your legal health record.

What if I am not capable of having this conversation?

Goals of Care will be discussed with your substitute decision-maker if you are not capable of making health care decisions.

I already have an advanced directive. Do I need Goals of Care?

An advance directive supports your Goals of Care, but the Goals of Care form in the hospital record ensures these decisions are documented and accessible to your care team..

What if I want to change my Goals of Care designation?

You can request changes to your Goals of Care at any time. Updates are made directly in your hospital health record and reviewed regularly by your healthcare team.

I am healthy; do I need to have the Goals of Care conversation?

Yes, even if you are healthy, having this conversation early ensures your wishes are known in case your condition changes. It helps guide your care team in future unexpected events.