Who should I have a Goals of Care conversation with prior to issuing a GCD Order?
Anyone for whom it is clinically appropriate to have a conversation with, in order to determine a GCD. If you have any clinical or personal information about a patient that would make you question that a GCD other than R1 is to be considered, you should have a conversation with the patient (or proxy decision-maker) leading to a conjointly determined GCD. If it is obvious to you that an R1 designation is most appropriate, it can still be worthwhile to confirm this with many patients. For labouring women, and for some other very healthy individuals who are having an episodic health encounter in the system, the conversation could be viewed as intrusive and inappropriate. Wise clinical judgement will be the best guide.
