Goal-Concordant Care: End-of-Life Planning Conversations for All Seriously Ill Patients

Casarett, David; Lakis, Kristen; Jessica, E. Haberer; Gentry, Jennifer; Fischer, Jonathan; Ibrahim, Salam; Acker, Yvonne; Setji, Noppon

doi:10.1056/cat.22.0271

Cited by 8 publications

(6 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our study found a low prevalence of dGOCC after severe stroke. The results of this study are similar to studies that have identified a low prevalence of documented goals of care conversations in other life-threatening conditions (16–19). This finding has two possible causes: GOCC are occurring but not being documented (or identified), or GOCC are not occurring at high rates.…”

Section: Discussionsupporting

confidence: 87%

“…A total of 1297 patients were included in this study (Table 1). The majority of participants (54%, n=698) were women, the mean age was 69 years (SD 17), and the median initial NIHSS was 17 (IQR [13][14][15][16][17][18][19][20][21][22]. More than half of patients experienced their first stroke (61%, n=789), 33% (n=430) of patients received thrombolysis, and 32% (n=405) underwent thrombectomy.…”

Section: Resultsmentioning

confidence: 99%

“…Based on prior studies, both causes are likely to be at play. Prior studies have found both physicians and patients report a low rate of GOCC in critically ill patients, and prior studies report a low prevalence of GOCC documented in the medical record (19). Among the few patients with a GOCC, most patients only had one conversation and the conversation tended to be early during the hospitalization.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Documented Goals of Care Conversations with Hospitalized Patients after Severe Stroke

Comer,

Bartlett,

Holloway

et al. 2023

Preprint

View full text Add to dashboard Cite

Background: Identifying goals of care is important for patients suffering severe ischemic stroke (SIS) and their caregivers to ensure patient- and family-centered treatment decisions. This study sought to determine the prevalence and patient predictors associated with having a documented goals-of-care conversation (dGOCC) after SIS. Methods: We reviewed the medical charts of all patients with National Institutes of Health Stroke Scale (NIHSS) ≥10 admitted to four hospitals in the Midwestern US. In addition to sociodemographic and clinical characteristics, we searched for dGOCC during the acute stroke hospitalization, defined as any documented conversation or meeting that addressed one or more of the following domains: prognostic information, treatment plan, patient preferences and values, quality of life, or establishing goals. We determined prevalence, frequency, timing, and content of dGOCCs. Additionally, we obtained information on treatment utilization and outcomes. Results: Among 1297 patients, 26.5% (n=344) had at least one dGOCC. Treatment plan was the most discussed domain (n=264, 20% of all patients) and was the most common first dGOCC (n=207, 60% of first conversations). Median day for first dGOCC was on hospital day zero. Patient preferences, values, and goals were documented in 112 (8.6%) of all patients' charts and quality of life conversations were documented in only 61 (4.7%) charts. In multivariate analysis, having a NIHSS ≥21 (OR 1.46, p-value .01) was associated with having a dGOCC. Conclusion: After severe stroke, most patients do not have a dGOCC, despite the important decisions that often arise about treatment and rehabilitation. Documentation of patient preferences, values and goals are even rarer. This suggests missed opportunities for high quality decision making informed by patient goals to improve person centered care.

show abstract

Section: Discussionsupporting

confidence: 87%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Documented Goals of Care Conversations with Hospitalized Patients after Severe Stroke

Comer,

Bartlett,

Holloway

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…Physicians’ goals-of-care (GOC) conversations with seriously ill patients can improve outcomes, including pain and symptom control, reduced hospital readmission rates, reduced acute-care utilization, earlier hospice enrollment, and greater patient satisfaction (Casarett et al 2022; Temel et al 2010). Duke Health, which committed in 2016 to the goal of having a GOC conversation with patients in the last 6 months of their lives, improved the occurrence of these conversations from 3% of cases in 2016 to 50% by May 2022.…”

Section: Reimagining Elder Carementioning

confidence: 99%

“…Duke Health, which committed in 2016 to the goal of having a GOC conversation with patients in the last 6 months of their lives, improved the occurrence of these conversations from 3% of cases in 2016 to 50% by May 2022. The initiative included developing templates to guide the conversations, educating clinicians, instituting reminder triggers in the EHR, and tracking results (Casarett et al 2022).…”

Section: Reimagining Elder Carementioning

confidence: 99%

Reclaiming Healthcare’s Healing Mission for a Sustainable Future

Berry,

Yadav,

Hole

2023

Journal of Service Research

View full text Add to dashboard Cite

Healthcare in the United States has reached a point where it is unsustainable for the long term, particularly for the poor, the elderly, and healthcare workers (HCWs) themselves. We propose a framework for making U.S. healthcare more sustainable, whereby the service returns to its core mission of healing. The framework casts that healing mission in broadly applicable, practical terms, whereby leaders of healthcare organizations and in the wider for-profit, not-for-profit, and governmental healthcare ecosystem take concrete steps to improve outcomes for patients and HCWs. Those steps involve aligning healthcare resources, incentives, and policies with the core mission of healing and then implementing change in specific ways that particular organizations have already shown are achievable and sustainable. We use those examples to illustrate how healing-oriented innovations in healthcare delivery get deployed and how progress toward sustainability then ensues. Lessons from these efforts can be tailored to individual healthcare contexts and institutions—and then applied on a national scale. The discussed initiatives can also guide the direction of future research on healthcare sustainability.

show abstract

The Use of Templates for Documenting Advance Care Planning Conversations: A Descriptive Analysis

Schlichte¹,

Setji²,

Walter³

et al. 2023

Journal of Pain and Symptom Management

View full text Add to dashboard Cite

Goal-Concordant Care: End-of-Life Planning Conversations for All Seriously Ill Patients

Cited by 8 publications

References 10 publications

Documented Goals of Care Conversations with Hospitalized Patients after Severe Stroke

Documented Goals of Care Conversations with Hospitalized Patients after Severe Stroke

Reclaiming Healthcare’s Healing Mission for a Sustainable Future

The Use of Templates for Documenting Advance Care Planning Conversations: A Descriptive Analysis

Contact Info

Product

Resources

About