Testing a new form to document ‘Goals‐of‐Care’ discussions regarding plans for end‐of‐life care for patients in an Australian emergency department

Abstract

Having a Goals-of-Care form in emergency medicine is supported; the ideal contents of the form was not determined.

Review article: Goals‐of‐care discussions for adult patients nearing end of life in emergency departments: A systematic review

“…In a single-centre study, Mills et al designed a goals-of-care form for ED usage focused on patient values that was intended to guide and stimulate discussions, but many clinicians preferred it to focus on treatment limitations and did not complete all sections. 28…”

“…Jelinek et al 26 This Australian multicentre qualitative study generated suggested improvements across four areas of healthcare services for patients with advanced cancer presenting to EDs, related to clinical care, pathways, information access and education Argintaru et al 27 This Canadian multicentre qualitative study found that most ED clinicians have frequent goals-of-care discussions, believe it to be within the scope of their practice and feel well trained in them, but noted barriers to their implementation in this setting and uncertainty regarding the ideal facilitator Mills et al 28 This Australian single-centre mixed-methods study found that most doctors supported using a form to document goals-of-care discussions in EDs but that they used it more to guide treatment limitations rather than documenting patient preferences and values. The most valued section was 'aims-of-care' adopted.…”

“…26 Ideal timing of discussions in EDs was not determined, although two studies found that ED-led conversations took an average of 10 min. 25,28 The ideal discussion facilitator was not identified. Most ED clinicians in a large qualitative study noted that they conducted goals-of-care discussions frequently, felt they were within their scope of practice and were adequately trained.…”

“…Requirements for ED discussions 5 [24][25][26][27][28] Content of ED discussions 1 24 Variations in content for EDs compared with other settings 0 Variations in content for CALD populations 0 Documentation of discussions to meet patient and clinical needs 1 28 Harms and benefits of discussions in EDs 1 25 not involved in its design, and we might have omitted aspects of the topic that would have been important to them. There might also be varied research interpretations of the term 'goals-of-care' given the lack of standardisation in definitions and understanding.…”

Should every patient have goals of care discussed in the emergency department? Yes

“…If we reflect on our daily routine, we practise shared decision making and are defining goals in all patients presenting to ED. Planning of care means starting the conversation, creating a proactive space towards shared decision making, identifying our patients' and/or relatives' perception of illness and trajectory independent patient's prognosis, and focusing on the aims of care rather than solely on the ceiling of care . All patients benefit from the dialogue around the expectations of their journey in hospital independent of being critically unwell or presenting with chronic medical issues.…”