What are the primary goals of C1 (Comfort Care Level 1) comfort care?

Primary Goals of C1 Comfort Care

The primary goals of C1 comfort care are to maximize physical comfort through aggressive symptom management, preserve quality of life and dignity, and prevent distressing symptoms—particularly pain, dyspnea, and suffering—while neither hastening nor postponing death. 1, 2

Core Objectives

Physical Comfort and Symptom Control

• Relief from distressing physical symptoms is the paramount goal, including management of pain, breathlessness, nausea, and other sources of discomfort through diligent medication titration 1, 3
• Dyspnea control follows a graduated approach: mild dyspnea is addressed by treating underlying disease and psychosocial factors, while severe dyspnea requires facial cooling, opioids for refractory breathlessness, and consideration of palliative sedation for intractable suffering 2
• Pain management requires systematic assessment using established protocols, as physical discomfort dominates patients' attention and disrupts their orientation to the world 2, 4

Quality of Life Preservation

• Maintaining or improving quality of life takes precedence over prolonging survival, with care focused on what patients notice and value: function, symptoms, and health-related quality of life 1
• Comfort is multidimensional and characterized by relief from physical discomfort and feeling strengthened in one's ability to cope with illness challenges 5
• The goal is to achieve relief—even temporary relief—from the most demanding discomfort, rather than an ultimate state of peace 4

Dignity and Psychological Well-being

• Preservation of dignity and addressing spiritual, psychological, ethical, and social needs are fundamental goals alongside physical comfort 1
• Comfort care affirms life and regards dying as a normal process, aiming neither to hasten nor postpone death 1
• Supporting patients' sense of control and belonging reduces suffering and improves the dying experience 6, 5

Treatment Approach

Medical Management Simplification

• Strict glucose and blood pressure management are not necessary in comfort care; medication plans should be simplified and potentially withdrawn when they no longer serve comfort goals 1
• Lipid management intensity can be relaxed, and withdrawal of statins may improve quality of life in patients receiving palliative care 1
• Antibiotic use should be evaluated based on whether treatment will improve specific symptoms (e.g., treating urinary tract infection for dysuria relief, treating thrush for dysphagia improvement) rather than prolonging survival 1

Avoiding Burdensome Interventions

• Diagnostic testing should be limited to what directly informs comfort measures; frequency of monitoring (including blood glucose checks) should be reduced 1
• Artificial nutrition and hydration decisions must weigh whether procedures will improve the patient's comfort versus creating additional burdens (e.g., requiring physical restraints) 1
• Life support should not be continued without offering patients and families the alternative of care focused entirely on comfort, as prolonged aggressive care may reduce quality of life near its end 1

Family and Caregiver Support

Communication and Decision-Making

• Advance care planning conversations should determine the individual's goals of care, with documentation of preferences regarding feeding tubes, hydration, treatment intensity, and place of care 1
• Prognostication discussions must address realistic expectations about survival and quality of life outcomes to guide treatment planning 2
• Respectful discussion of patient values should be balanced with information about medically appropriate treatment options 1

Ongoing Support

• Families should be involved in planning and providing care to the extent desired by the patient, with psychological support beginning before death and continuing through bereavement 2
• Interdisciplinary team involvement—including social work and chaplaincy—is essential, as suffering at end of life is multidimensional 3

Critical Pitfalls to Avoid

• Comfort care does not mean "giving up"—it represents a shift in treatment focus toward aggressive symptom management rather than disease modification 2
• Avoid delaying comfort care transitions until curative efforts fail; this outdated dichotomous model delays essential symptom management 2
• Do not continue treatments that cause discomfort without clear benefit to the patient's comfort or quality of life 1
• Frame care transitions carefully to avoid creating feelings of familial abandonment; use language that emphasizes continued active care focused on comfort 3