A Good Day Is a Valuable Day: How complex care decisions can be guided by one simple question
What makes care truly valuable to patients living with cancer? In this blog, we explore how the question “What is a good day for you?” opens the door to goal-oriented care. In goal-oriented care, medical decisions are aligned with the patients’ life goals and directed by what really matters to people. The story of Mrs. Van Dongen shows us how life goals, care goals, actions and strategies and their underlying values can be brought into harmony.
Author
Pauline Boeckxstaens
Introduction
Cancer care is often about life and death. Understandably, both patients and professionals are drawn to actions and strategies focused on treatment, life extension and rescue. But this focus on clinical outcomes can obscure a deeper, more personal truth: people with cancer live lives, not just diseases.
In oncology research, there is growing recognition that patient value must include more than survival statistics. It must reflect how treatments affect a person’s daily life, goals, and identity. Yet, too often, decisions still start with treatment options, not with the person.
One powerful way to turn that around is deceptively simple:
“What is a good day for you?”
When Treatment and Life Goals Clash
Mrs. Van Dongen, 78, lives alone. She has metastatic breast cancer. Her oncologist proposes chemotherapy that might extend her life by several months. But the treatment brings risks: fatigue, nausea, and frequent hospital visits.
When her general practitioner asks what a good day looks like, her answer is immediate:
“A walk in the park, coffee with my daughter, and reading in the evening.”
That answer shifts everything.
Her care team realizes that prolonging life at the cost of daily well-being may not serve her goals. In dialogue with Mrs. Van Dongen, they decide against chemotherapy. Instead, care focuses on comfort, mental clarity, and preserving routines as the ingredients of her “good day.”
The Heart of Goal-Oriented Care
Mrs. Van Dongen’s story illustrates goal-oriented care, an approach grounded in the person’s values and life goals. It begins not with treatment, but with questions like:
- What matters most to you now?
- What do you want your days to look like?
- What are you hoping for?
From those answers, we derive care goals — and only then do we choose interventions, actions and strategies that support them. This flips the script on traditional care, where the treatment strategies often dictate the care plan.
Goal-oriented care is grounded in the deeper values that people hold such as autonomy, dignity, connection, peace and uses these values to direct difficult decisions and moral dilemmas in (cancer) care. A reflection on goals and their underlying values also a way to visualize implicit tensions between professionals’ goals (e.g. tumor control) and patients’ priorities (e.g. staying out of the hospital) that can cause resistance and friction during a care trajectory.
A Framework for Reflection
When care teams struggle with resistance, frustration, or uncertainty, it often helps to pause and map the situation. A helpful model is this visual from Flemish research on goal-oriented care that disentangles life goals, care goals and strategies. Especially in situations with different perspectives and even moral dilemma, the underlying values of the people involved can help professionals and patients to better understand the drivers of the different strategies that are pushed or resisted by people involved. In these situations, goal-oriented care starts from the assumption that it is the patient who primarily decides on the goals that are meaningful to them.
Conclusion
“What is a good day for you?” is not a soft question. It’s a clinical one. It cuts to the heart of what makes life meaningful to people and thus should serve as our compass to guide decisions, especially in clinical situations of complexity and uncertainty.
As researchers and clinicians, we design treatments that cure or prolong life but unless they serve a life worth living to the person, we risk missing the point when just implementing them without reflection on the underlying purpose or goal of these actions. In oncology care, value is not found only in metrics. It is found in the mornings at the park, shared cups of coffee, and quiet moments that still feel like home.
Author bio
Professor Dr. Pauline Boeckxstaens is a family physician and researcher with a passion for person-centred and goal-oriented care. She focuses on how clinical reasoning processes in cases of complexity, disagreement and uncertainty can be guided by the things that matter most to the patient.