The importance of incorporating goals of care
into end-of-life discussions has become more obvious
in light of evidence questioning the ability of
intervention-oriented advance directives to improve
end-of-life care.15,37 Such evidence leads to the conclusion
that advance care planning should focus more
on goals of care and less on specific interventions,
because advance directives usually cannot anticipate
the specific clinical circumstances that will pertain
in a patient’s future.17 The importance of goals is
also evident in discussions about cardiopulmonary
resuscitation (CPR), which tend to focus narrowly
on interventions and may thereby neglect more
important issues related to the overall trajectory of
illness or the process of dying.