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Table 3 Comparison of features of a ‘components of care’ approach to NFR versus the ‘system of care’ approach captured in the Goals of Patient Care form in the hospital setting

From: Development of a video-based education and process change intervention to improve advance cardiopulmonary resuscitation decision-making

‘Components of Care’ approach ‘Goals of patient care’ approach
Applies to small % of patients Applies to large % of patients
Inconsistently records surrogate decision-maker and available advance care planning documents. Routinely records surrogate decision-maker and availability of advance care planning documents.
Completed just before death, often by non-treating team Proactively completed as part of routine care by treating team
Part of overall treatment plan, with 4 specific goals
Medical escalation plan outlining use of individual components of treatment Medical escalation plan which is goal and system oriented
Associated with sub-optimal care Associated with improved quality of care
Misses patient preferences Seeks and records patients’ goals, values and preferences.
Sequential model of care with sharp demarcation from life prolonging care to palliative care Introduces symptomatic palliative care earlier in illness trajectory
Hospital, time limited, medical treatment order (ie doctor to doctor communication) Orders can be endorsed beyond the current admission (potential to be an ongoing advance care plan)