Goals of Care in the COVID-19 environment

“All will be cared for”

Current Interim Guidance for Health Professionals April 2020

This information has been developed for health professionals and is not intended for use by consumers. See related links for consumer information.

These resources were produced by the WA Cancer and Palliative Care Network (WACPCN) in consultation with clinicians. They were developed to assist clinicians to respond to the care planning needs of all patients in the evolving COVID-19 environment. The resources are not intended to replace specialist consultation, advice or experience.

This current guidance will be reviewed and updated, changed and replaced as new information becomes available. Return to this website regularly for live information, rather than storing printed local copies from these webpages.

Goals of Care

Goals of Care establishes the most medically appropriate, realistic, agreed goal of patient care that will apply in the event of clinical deterioration, during an episode of care. This clinical care planning process facilitates proactive shared discussion and decision-making between the clinician, patient and family/carer.

Goals of Care overview

The need to develop a clear, consistent and effective approach to establish the goals of medical care for patients admitted into West Australian hospitals, has resulted in the development of a state-wide Goals of Patient Care Summary (PDF 62KB). This clinical document, developed by an expert working group in July 2017 prompts and facilitates proactive shared decision making between treating clinicians, patients and their families.

Current Interim Resources for Goals of Care April 2 2020

This section is intended for clinicians seeking information on how to complete Goals of Care clinical documents.

Clinicians will find live information in this section to support use of both types of clinical documents. The information provided is not meant to replace clinical judgement or specialist consultation; rather it is intended to clarify and strengthen clinical care planning/management and supported/shared decision making for all patients, families and clinicians in the COVID-19 environment.

Two types of these documents are used across Western Australia:

Clinicians new to Goals of Care are advised to familiarise themselves with the below resources:

Goals of Care conversations and communication tips

This section is intended for clinicians seeking information on how to conduct Goals of Care conversations.

Additional resources

Reproduced with permission from Dr Ioana Vlad, Consultant Emergency, Sir Charles Gairdner Hospital, Perth.

Clinical assessment tools

Increasingly, health consumers, clinicians and systems are considering the importance of patient centred treatment decisions. This is especially true when undertaking anticipatory care planning for deterioration in the COVID-19 environment. Clinicians have a responsibility to provide honest information to assist patients and families when deciding treatment. This should be done in light of their values, changing health/illness and real options for future care.

This process relies on clinician recognition of patients who may be at risk of clinical deterioration, approaching end-of-life or transitioning to the terminal phase. Failure to identify these patients can reduce their quality of care through delays in timely comfort care and prolonged exposure to non-beneficial treatment.

Clinical Indicators can be used to identify when to initiate Goals of Care conversations. Clinical Indicators are screening tools designed to support hospital teams to recognise patients at risk of deteriorating and/or dying.

SPICT aims to reduce the impact of prognostic ambiguity and improve clinician confidence in identifying these patients earlier in the course of the hospital admission, or earlier in the course of illness.

Current Interim Resources for clinical assessment tools April 2 2020 Resources in this section include how to use guides, the blue SPICT for health professional and the green SPICT developed for patients, family and professionals carers.

Supportive and Palliative Indicators Tool (SPICTTM)  

The SPICTTM is used to identify people with deteriorating health due to one or more advanced conditions. It guides holistic assessment and care planning.

SPICT for health professionals

SPICT for patients, family and professional carers

Additional resources 

The SPICT™ tool is available as a free app on iOS for iPhone and iPad, and as an app for Android.

The latest version of the SPICTTM app includes information about the SPICTTM, advice on how to assess and plan care for people identified with it, and tips on effective communication:

Note: all users are responsible for ensuring that they use the current version of SPICT-App and for any use they make of SPICT™ and SPICT™ website resources.

Train the trainer workshops
Goals of Care and end-of-life in the COVID-19 environment - Train the Trainer workshops – 19 March 2020 

The workshops facilitated by Dr Simon Towler, Intensivist, Fiona Stanley Hospital and WA Cancer and Palliative Care Network Clinical Lead (End-of-Life Care) and Valerie Colgan, Staff Development Educator, Clinical Implementation Unit, WA Cancer and Palliative Care Network.

Attendees identified useful clinical resources and current health service planning for training in this environment. The Workshops provide an opportunity for collective thinking and sharing to improve clinical training during COVID-19 management.

Dr Simon Towler’s presentations

  • Goals of Care and end-of-life in the COVID-19 environment introduction 
  • Goals of Care
  

Additional resources  

Grand round presentations – Royal Perth Hospital – 18 March 2020

Password: RPHPGME

COVID-19 End of life and Palliative Care Resources

Symptom management of unwell adult patients with COVID-19

Symptom management of severe or critical illness in adult patients with COVID-19

Symptom management of adult patients dying with COVID-19

Additional end of life and palliative care resources

Spotlight on pharmacological interventions for palliative care symptoms the following videos have been developed for personal professional development or use as an education resource:
Acknowledgements: Penelope Tuffin, Advanced Practice Pharmacist, Palliative Care and Pain Management, and the Cancer Council WA
Ethical decision-making and professional support

Ethical challenges in health care are common even under normal conditions because health care responds to human suffering. To act ethically should be integral to professionalism in health care. However, professionals often experience uncertainty or distress about how to proceed during public health emergencies.

Last reviewed: 30-04-2020