Navigating end-of-life conversations: A reflection on goals of care in Nepal

Goals of care (GOC) discussions and advance care planning (ACP) emphasize patient's autonomy and dignity in healthcare delivery. These discussions become crucial as individuals approach the terminal phase of their illness, enabling them to make informed decisions about their end-of-life care (EOLC). Globally, there is a rising trend in discussions related to GOC, especially among those with serious or chronic conditions. In Asian countries, including Nepal, cultural factors, family dynamics, and limited awareness among healthcare professionals hinder ACP implementation. Nepal faces challenges in healthcare accessibility, with a significant portion of healthcare expenditure directed toward the elderly population. Palliative care medicine has made some progress in Nepal, despite the scarcity of its resources. Cultural influences contribute to healthcare providers' and patients' unawareness and limited proactive involvement in end-of-life decision-making. The integration of GOC discussions in Nepal's healthcare system is imperative to ensure access to basic palliative care resources in both rural and urban areas. Efforts should focus on addressing challenges in palliative care and promoting understanding of GOC concepts with clear documentation, comprehensive EOLC plans, and increased awareness among both healthcare providers and the public. Implementing a centralized record system can enhance nationwide access to GOC information, contributing to a patient-centered healthcare system.