Goal-setting for palliative care requires full and open discussion with the patient, family, carer and all relevant medical and nursing staff. Goals may range from the patient wishing to maintain and improve functional levels, improve eating ability, return to work, go to a family wedding or other social event, and wishing to be cared for at home when required. Allied health staff can bring their professional expertise to the discussion and help the patient to set achievable goals through assessment, reassessment, rehabilitation programs, exercise, counseling, education and assistive equipment.
Of course, the type of assistance provided needs to be reviewed regularly so that if a patient's ability to manage their goals or functional level changes, then treatment and assistance can be appropriately modified in response.
Goals can be as simple as maintaining walking / activity levels / communication, and eating well, or as complex as continuing to work in employment or maintain a garden. Goals may need to be adjusted but this does not mean having to cancel them altogether. Allied health professionals are well trained to assist the patient and family to adapt and develop their goals to match their changing needs. Counselling and support is essential to assist with emotional and psychological issues that arise with fluctuating physical capacities and thus changing goals.
Sometimes assisting also means encouraging patients to make space for their needs amidst all their other appointments, and to take time out for themselves, learning to prioritise and live as fully as possible each day. For example, patients undergoing grueling chemotherapy may wish to negotiate a break between treatments in order to attend a special event and respite can be organized to assist carers.
Allied health professionals require excellent communication and education skills to assist patients in palliative care. Patients need to be supported to feel safe and to achieve their goals, against the context of fluctuating or deteriorating skills (physical / functional/ emotional / psychological / communication) and their decreasing ability to remain independent. Assisting a patient to re-evaluate their goals and to reflect realistically on what they are able to achieve, at the same time as they are losing functional abilities, is quite difficult to achieve, but very important.
Not everyone understands or is ready to accept the functional decline that occurs at end-of-life and may talk in terms of getting better. Using the phrase 'Let’s plan for the hardest days and the good days will take care of themselves', when talking to the patient can be helpful as it accommodates the patient’s hope along with the reality of a pending functional decline. Another option is to provide the person with contact people in the event of difficulties in the future.
Care at the very end-of-life is another area for specific goal setting, either in hospital or home environments. Allied health professionals are essential at this time to assist patients who decide to die at home as they can supply equipment, and provide education and support (psychological, emotional, spiritual, and practical) for the patient and their family / carer. This support can also be offered in the hospital or palliative care unit.
An interdisciplinary approach is essential in assisting patients with their goals. It is important to ensure that these plans or goals are discussed at case conferences and family meetings to gather and share accurate information so that the goals set are achievable and followed through. Allied health professionals need to ensure support for themselves as they work through these often difficult issues with patients.