PATIENT GOAL ACTIVITY SUMMARY
Goal Activity Sessions:
| Goal Statements |
Strongly
Disagree |
Neutral |
Strongly
Agree |
||
|---|---|---|---|---|---|
| Relevant to Anti-cancer Treatment Decisions | |||||
| 1. I want to do all I can to feel well even if it means stopping the treatments for my cancer. | |||||
| 2. I want to receive treatment for my cancer as long as I believe treatment will help me feel better. | |||||
| 3. I want to receive treatment for my cancer as long as my doctor believes treatment will help me feel better. | |||||
| 4. I want to receive any treatment that might cure my cancer. | |||||
| 5. I want to receive any treatment that might help me live longer. | |||||
| 6. I want to receive treatment for my cancer as long as I believe treatment will help me live longer. | |||||
| 7. I want to receive treatment for my cancer as long as my doctor believes treatment will help me live longer. | |||||
| 8. I want to feel as well as possible even if it means stopping treatment for my cancer and I may not live as long. | |||||
| 9. I want to spend as much time as possible with my family and friends even if it means stopping treatment for my cancer. | |||||
|
Strongly
Disagree |
Neutral |
Strongly
Agree |
|||
| Relevant to EOL Treatment and Care Decisions | |||||
| 10. I do not want to die connected to life-supporting machines. | |||||
| 11. I do not want to die connected to life-supporting machines unless there is a realistic chance of recovery. | |||||
| 12. I do not want to die to connected to life-supporting machines even if this means I will die sooner. | |||||
| 13. I want to die at home with my family and friends. | |||||
|
Strongly
Disagree |
Neutral |
Strongly
Agree |
|||
| Relevant to Communication Preferences | |||||
| 14. I want my cancer doctor to talk about what will happen when I stop cancer treatments. | |||||
| 15. I want my cancer doctor to tell me how long I might live with and without cancer treatments even if it is not what I am hoping for. | |||||
| 16. I want to be told when my cancer doctor believes cancer treatments are more harmful than helpful. | |||||
| 17. I want to be told when my cancer doctor believes life support offers no meaningful chance of recovery. | |||||
| 18. I want to be told when my cancer doctor believes I am dying. | |||||
|
Strongly
Disagree |
Neutral |
Strongly
Agree |
|||
| Relevant to Being Known (Values) | |||||
| 19. I want to do all I can to feel well. | |||||
| 20. If I had to choose between living longer but feeling worse and living a shorter time but feeling better, I’d choose feeling better. | |||||
| 21. I want to focus on living in the present and not worry about the future. | |||||
| 22. I want to maintain my daily routine and responsibilities for as long as possible. | |||||
| 23. I do not want my cancer treatment to cause practical or financial hardship for my family or friends. | |||||
| 24. I want my family and friends to know my wishes so they can help me receive the care I want as my life is ending. | |||||
| 25. I want my family and friends to feel prepared for when I am gone. | |||||
| 26. My religious or spiritual beliefs are important to my decisions about cancer treatment and end of life care. | |||||
| 27. I want to be prepared for a time when the quality of my life is too poor to continue treatment. | |||||