Comprehensive Geriatric Assessment
Future wishes, goals and anticipatory care
Elicit what matters to the person and convert it into meaningful goals. Incorporate advance care planning, treatment preferences and future wishes appropriately.
Learning objectives
• Elicit what matters to the person and convert it into meaningful goals. • Incorporate advance care planning, treatment preferences and future wishes appropriately. • Recognise when capacity, consent or best-interests processes are required. • Document uncertainty, escalation planning and review without reducing care to DNACPR status.
Learner handbook (PDF)
Open source ↗Why this module matters
CGA should ask what matters now and what should happen if health deteriorates. Future wishes need to be integrated, not appended at the end.
Core teaching
Future wishes are a core CGA domain. They include the person’s priorities, fears, acceptable trade-offs, preferred place of care, advance planning and treatment preferences. These discussions should be proportionate to the clinical situation and should not be reduced to a resuscitation decision.
BGS explicitly includes future wishes within contemporary CGA. The information from other domains helps make these discussions realistic: functional trajectory, frailty, cognition, treatment burden and social circumstances all influence what choices mean in practice.
Where capacity is uncertain, the appropriate legal framework must be used. Where preferences are known, they should shape the care plan. Anticipatory plans should specify what to do if predictable deterioration occurs, who to contact and when the plan should be reviewed.
Case step
Mrs Morgan says her priority is to remain at home if possible and to avoid repeated hospital stays, but she would accept treatment for reversible illness. This should shape escalation and follow-up planning without assuming she is “for comfort care only”.
Interactive element
Goals conversation branching case: learner selects person-centred language, identifies when capacity/consent questions arise, and drafts anticipatory triggers without reducing planning to DNACPR.
Practice points
- Document baseline as well as current state.
- Use collateral information when history is incomplete.
- Convert every important finding into an action or explicit decision not to act.
- State uncertainty rather than disguising it as a score.
- Name ownership and review whenever the plan crosses teams or settings.
Reflection prompt
How will you ask about future wishes without making the conversation feel like a resuscitation-only discussion?
