Implementierungsleitfaden Therapieziele Onkologie - Local Development build (v1.0.0-ballot) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Therapieziele (Goals)

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Therapy goals — what this guide is about

A therapy goal is the intended state that patient and care team agree on for an oncological treatment. It is the central subject of this guide, represented as a FHIR Goal in the OnkoTherapyGoal profile. A goal answers what should be achieved, not what is done (the latter being requests such as ServiceRequest/MedicationRequest). The goal type is coded from OnkoTherapyGoalType (cure, life prolongation, symptom control, quality of life, preservation of function). Study participation is deliberately not a goal type — it is a means (investigational line of therapy, iLoT per EnLiST), not a patient-side target state.

Goal type is not therapy intent — two axes

The goal type (Goal.category) and the therapy intent (OnkoTherapyIntent, SNOMED hierarchy 362961001 | Procedure by intent) answer different questions and must not be conflated:

	Therapy intent	Goal type
Question	With what orientation is treatment given?	What state should be achieved?
Perspective	Procedure / line of therapy	Patient / outcome
Values	curative, palliative, neoadjuvant, adjuvant, supportive	cure, life prolongation, symptom control, quality of life, preservation of function
Location	extension on episode (required), plan, goal	Goal.category

The axes correlate but are not redundant: in the mCRC scenario the intent stays palliative while the goal type shifts between life prolongation and maintenance; in the breast cancer scenario the neoadjuvant line carries the curative overall goal. Neither axis alone could express this.

For the patient-centered goal types: the category follows the level of assessment, not the instrument. Symptom-level assessment (scale or elicited symptom burden) → symptom control; a concrete, nameable function or structure → preservation of function; globally patient-reported — via standardized PROM or structured interview (e.g. SEIQoL-DW, goals-of-care conversation) → quality of life. For a given target exactly one category is correct; combining categories on one goal remains possible where several target states are genuinely pursued (e.g. cure and breast conservation).

Preservation of function is a patient-prioritized goal that can steer the choice of measures in both directions — de-escalating surgery (continence or larynx preservation) as well as intensifying prior therapy (neoadjuvant systemic therapy that enables breast conservation in the first place) — and its achievement is tracked independently: it can fail (not-achieved) while the curative goal is still pursued.

The semantic anchoring of the goal types in SNOMED CT (target-state concepts, not intent qualifiers) is documented in the ConceptMap Goal types → SNOMED CT.

The goal is primary — the plan follows

A Goal is a standalone resource that precedes the care plan: the goal is set first (shared decision / tumor board), then the CarePlan is formulated to pursue it. CarePlan.goal is therefore a pursuit reference, not ownership.

Two layers, and a strategy change replaces the goal

Goals occur on two layers: exactly one active overarching goal carrying the strategic intent (curative vs. palliative), plus optional episode goals for individual treatment phases. On a strategy change (curative → palliative on progression) the overarching goal is not mutated but closed and replaced by a new one (linked via replacement); a successfully completed goal, by contrast, hands off to its follow-up goal via predecessor/successor.

The intent is set at the point of recommendation

The strategic intent is fixed where therapy is recommended — typically the interdisciplinary tumor board. This is why recommendation and actual treatment are distinct objects; see Recommendation and treatment plan.

Beyond oncology

The listed goal types and the curative/palliative intents are not exhaustive; other entities carry further specialised intents/phases (e.g. induction/consolidation/ maintenance in haematological disease). The structure is disease-agnostic; dedicated pages for further conditions (diabetes, asthma, IBD, chronic kidney disease/dialysis) are envisaged.