12
Treatment
Establishing Goals of Care
Recommendation 8
➤ Comprehensive disease-specific multidisciplinary input should be
attained before defining "goals of care" or undertaking therapeutic
discussions with patients. Those involved in management decisions
should include specialists highly experienced in treating ATC. (S-L)
Good Practice Statement 3
➤ Patients must have understanding and decision-making capacity
to consent to treatment or to make particular medical decisions.
Concerns about diminished or impaired capacity should prompt
mental health and/or clinical ethics consultation to assess barriers to
capacity. (GPS)
Good Practice Statement 4
➤ Patients should be encouraged to draft both an advance directive in
which they name a surrogate decision maker and list code status and
other end-of-life preferences including POLST or MOST document.
Circumstances where suspension of DNR may occur must be
discussed with the patient as well. (GPS)
Good Practice Statement 5
➤ A "goals-of-care" discussion should be initiated with the patient as
soon as possible. In consultation with a multidisciplinary team, a
candid session should be conducted in which there is full disclosure
of the potential risks and benefits of various treatment options,
updated frequently, including how such options will impact the
patient's life. Treatment options discussed should include all end-of-
life options, such as hospice and palliative care. Patient preferences
should guide clinical management. (GPS)
Recommendation 9
➤ The treatment team should include palliative care expertise at every
stage of patient management to help with pain and symptom control,
as well as addressing psychosocial and spiritual issues. (S-L)
Recommendation 10
➤ The treatment team should engage hospice care for ATC patients who
decline therapies against their tumor intending to prolong life, yet
who still require symptom and pain relief spanning the remainder of
their illness. (S-L)
