Goals of Care

Goals of care are the personal priorities, values, and treatment preferences that guide medical decisions during a serious illness. They cover what kinds of treatments a patient wants (or does not want), what quality of life they hope to preserve, and how they want to spend their time as the disease progresses. A goals-of-care conversation is a structured discussion (usually with the oncologist, palliative care team, or primary doctor) to align the medical plan with what matters most to the patient.

Origin

The phrase emerged from the modern palliative care and hospice movements of the 1970s–1990s, which emphasized matching treatment intensity to patient values rather than defaulting to maximal intervention. It became a standard clinical term after organizations such as the American Society of Clinical Oncology and the National Consensus Project for Quality Palliative Care formalized goals-of-care discussions as a quality-of-care measure.

Significance in Asbestos Context

For someone diagnosed with mesothelioma, asbestos-related lung cancer, or advanced asbestosis, goals-of-care conversations are especially important because treatments can be aggressive (extrapleural pneumonectomy, pleurectomy/decortication, multi-line chemotherapy, immunotherapy) and prognosis is often limited. Patients deserve a clear explanation of what each treatment is likely to achieve (cure, life extension measured in months, symptom relief, or none of those), so they can weigh the trade-offs in side effects, hospital time, and recovery. These conversations also shape decisions about clinical trial participation, transitioning to hospice, pain and breathlessness management, and where the patient wants to be cared for at the end of life. Documenting goals of care in the medical record can also matter for a legal claim: notes about symptom burden, functional decline, and the impact of disease on daily life become part of the evidence of damages.

Example Sentence

After her second line of chemotherapy stopped working, the palliative care team sat down with the family to revisit her goals of care and decide whether another treatment cycle or home hospice better matched what she wanted.

Related Terms

Palliative Care, Hospice, Advance Directive, Prognosis, Quality of Life, Shared Decision-Making

Notes

• Ask your oncologist directly: "What is the realistic best case, worst case, and most likely case with this treatment?" This is the clearest way to align decisions with your values.
• Request a palliative care consult early, not just at the end; studies in mesothelioma and lung cancer show earlier palliative involvement improves quality of life and sometimes survival.
• Put your decisions in writing through an advance directive, living will, or POLST/MOLST form, and give copies to your family and treating hospital.
• Keep a personal log of symptoms, fatigue, pain, and limitations on daily activities. This both informs goals-of-care discussions and supports documentation of damages in an asbestos claim.
• Bring a trusted family member or friend to these conversations; decisions made under stress are easier when someone else is taking notes and asking questions with you.