PATIENT'S GOAL(S) FOR CARE Short term goals that are realistic and consistent with end-of-life care and comfort.
CONSULTATION PROCESS Brief summary of the process you went through in the consultation (e.g. persons with whom you talked, meetings held and the names of those attending.)
RECOMMENDATIONS Describe what you are recommending as interventions and referrals. Include medical, psychosocial and spiritual interventions and discharge planning if appropriate.
CONSULTANT INFORMATION Clearly identify the names of the consultants and how they can be reached if there are further questions or concerns.
Physical Symptoms Evaluate current level of symptom distress. Edmonton scales, onset, location, aggravating and relieving factors, quality, intensity, and effect on ADL. Prior interventions to relieve symptoms and impact of interventions. Patient's understanding of symptom causality. Patient's goals for symptom relief. Patient's desire for further diagnostic evaluations. Likely progression of disease based on patient's pathology.
Short Term Goals oriented toward comfort and most meaningful to patient Review planned interventions in relation to goals- advancing or burdening (ex. Blood work, VS)
Assess family issues: patient's and family's perspectives Provide conflict resolution counseling if needed
Psychological/Spiritual Needs Fear of dying Anxiety about the after life
Denial of impending death Concerns about family, finances, etc. Search for meaning within personal suffering
Assessment of support system: family, friends, community- church, work, neighborhood, other. Evaluate involvement, capabilities, and coping of each.
Discharge planning issues: Remain in acute care hospital Returning home with or without hospice or home care LTC with or without hospice SNU Inpatient hospice care