The goals of care framework and the perioperative period: A practical approach

The goals of care (GOC) framework (2014) is an illness phase categorisation system that enables limitations of medical treatment (LOMT) to be documented and communicated within a healthcare system. It incorporates a clinical assessment of illness phase and GOC discussion on aims and LOMT for an episode of care. Together, this results in documentation of a GOC category that guides treatment escalation decisions during episodes of patient deterioration. Confusion exists about incorporating this framework into the perioperative period, particularly management of treatment escalation required for patient survival during surgery that is at variance with agreed goals and limitations. A historical tendency for automatic and unilateral suspension of limitations during surgery may be susceptible to ethical or medicolegal challenge. This article highlights the difference between the GOC framework and 'not for resuscitation' framework, considers the unique considerations of the perioperative period and addresses misconceptions of the GOC framework in patients undergoing surgery. Finally, it provides an approach to the GOC framework for patients considered for surgery by emphasising illness phase assessment and the need for the GOC category to accurately reflect the clinical situation throughout the perioperative period, guiding treatment escalation intraoperatively and postoperatively.