Goals of care discussions
Understanding Goals of care discussions
Goals of care discussions help patients and families articulate what matters most as they navigate serious illness — clarifying treatment preferences, quality of life priorities, and the balance between curative interventions and comfort-focused care. Medical social workers facilitate these conversations with sensitivity, ensuring that patient values and wishes are documented and communicated to the entire care team.
These conversations are not about giving up — they are about making informed choices that align medical care with personal values. Whether a patient prioritizes maximum independence, pain control, time with family, or aggressive treatment of their condition, establishing clear goals ensures that every member of the care team is working toward the same objectives and that care decisions reflect the patient's authentic preferences.
What Goals of Care Discussions Cover
Your social worker will guide a conversation about your understanding of your health condition, what you hope for from treatment, what you want to avoid, and how you define a good quality of life. Discussions may address preferences around hospitalization, life-sustaining treatments, pain management, and where you want to receive care. Family members and caregivers are welcome to participate.
Documenting and Communicating Your Wishes
Once your goals are clarified, your social worker ensures they are documented in your medical record and communicated to your physician, nursing team, and any specialists involved in your care. Goals of care are revisited periodically or when your condition changes, ensuring that your care plan continues to reflect your current values and preferences.
When to Contact Your Care Team
Contact your social worker if you want to revisit your goals, if your health status changes significantly, if you feel your care is not aligned with your expressed wishes, or if family members disagree about the direction of care. These conversations can happen at any time. If you experience a medical emergency, call 911 — emergency responders will follow any advance directives you have on file.
This educational resource is provided by CarePine Home Health for informational purposes. Always follow the individualized care plan developed by your healthcare team. If you have questions or concerns about your condition, contact your care team or call CarePine at 888.507.2997.
Medical Disclaimer: This information is intended for educational purposes only and does not replace professional medical advice. Always consult your physician or home health care team for personalized medical guidance.