Use and Meaning of “Goals of Care” in the Healthcare Literature: a Systematic Review and Qualitative Discourse Analysis

Secunda, Katharine E.; Wirpsa, M. Jeanne; Neely, Kathy Johnson; Szmuilowicz, Eytan; Wood, Gordoń; Panozzo, Ellen; McGrath, Joan M.; Levenson, A.R.; Peterson, Jonna; Gordon, Elisa J.; Kruser, Jacqueline M.

doi:10.1007/s11606-019-05446-0

Cited by 79 publications

(54 citation statements)

References 40 publications

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“…Patient-centred care, as highlighted in our study, includes the basic tenets of patients and/or family involvement in decision-making [ 24 ], of open communication between patients, families, and HCP [ 25 ], of sharing power and responsibility, and of accepting patients’ life choices [ 22 ]. Patients’ values, priorities, and goals are considered central to this care planning process, although patients do need to have an understanding of their illness to be able to participate fully in any discussions [ 26 ]. Gluyas et al (2015) have highlighted barriers to patient-centred care, including lack of continuity and fragmentation of care, as well as the power differential between patients and HCP.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of an End-of-Life Essentials Online Education Module on Chronic Complex Illness End-of-Life Care

et al. 2020

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Chronic complex illness/multimorbidity is a leading cause of death worldwide. Many people with chronic complex illnesses die in hospital, with the overall quality of end-of-life care requiring substantial improvement, necessitating an increase in the knowledge of the health professionals caring for them. End-of-Life-Essentials (EOLE) offers online education modules for health professionals working in acute hospitals, including one on chronic complex illness. A quantitative pre–post-evaluation analysis was undertaken on data from learners (n = 1489), who completed a questionnaire related to knowledge gained from module completion between December 2018 and November 2019. A qualitative post-evaluation analysis was also conducted using data on learner responses to a question posed between May and November 2019. Results showed a significant positive impact on learners’ knowledge, skill, attitude, and confidence in providing end-of-life care to patients living with chronic complex illness. The majority (82.9%, n = 900) intended to change their practice after module completion. A total of n = 559 qualitative comments were analysed thematically, with three major themes emerging: Patient centred care and care planning, Discussion of prognosis, and Valued communication skills. This evaluation has demonstrated that healthcare professionals could benefit from this education to improve quality of care of the dying.

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Section: Discussionmentioning

confidence: 99%

“…'Goals of care' is a term that is used increasingly in the end-of-life literature, often in the context of patient-centred care and care planning; however, the term can be interpreted in different ways [26]. It is often used to cover discussions about treatment intent and planning end stage care with patients [27].…”

Section: Patient-centred Carementioning

confidence: 99%

Evaluation of an End-of-Life Essentials Online Education Module on Chronic Complex Illness End-of-Life Care

et al. 2020

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“…11 The clinician needs to work collaboratively with the patient (and/or family) to explore preferences and develop a treatment plan that is respectful of, and responsive to, values. 12 In relation to timing, previous research suggests it is better to initiate GOC early in a patient's episode of care. 39 The doctor's clinical judgement alone is an unreliable trigger for GOC because clinicians frequently overestimate patients' prognosis.…”

Section: Discussionmentioning

confidence: 99%

“…9,10 Goals of care (GOC) is a communication and decisionmaking process that occurs between a clinician and a patient (or surrogate decision-maker) to facilitate a medical care plan that is consistent with the patient's preferences and values in the event of clinical deterioration. 11,12 The GOC process focuses on guiding current health care decisions during the episode of care, 13 including whether to utilise life-sustaining interventions. 14 This differs from the advance care planning (ACP) process which focuses on preparing for future health care decisions when a person can no longer make these decisions themselves.…”

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confidence: 99%

A Qualitative Exploration of Seriously Ill Patients’ Experiences of Goals of Care Discussions in Australian Hospital Settings

et al. 2020

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BACKGROUND: Goals of care (GOC) is a communication and decision-making process that occurs between a clinician and a patient (or surrogate decision-maker) during an episode of care to facilitate a plan of care that is consistent with the patient's preferences and values. Little is known about patients' experiences of these discussions. OBJECTIVE: This study explored patients' perspectives of the GOC discussion in the hospital setting. DESIGN: An explorative qualitative design was used within a social constructionist framework. PARTICIPANTS: Adult patients were recruited from six Australian hospitals across two states. Eligible patients had had a GOC discussion and they were identified by the senior nurse or their doctor for informed consent and interview. APPROACH: Semi-structured individual or dyadic interviews (with the carer/family member present) were conducted at the bedside or at the patient's home (for recently discharged patients). Interviews were audio-recorded and transcribed verbatim. Data were analysed for themes. KEY RESULTS: Thirty-eight patient interviews were completed. The key themes identified were (1) values and expectations, and (2) communication (sub-themes: (i) facilitators of the conversation, (ii) barriers to the conversation, and (iii) influence of the environment). Most

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“…[8][9][10] Several authors approach the original concept and its evolution. [11][12][13][14][15] Bioethics holds two converging viewpoints: the broader approach of global bioethics, considered to define policies and the narrower approach of biomedical ethics. Healthcare professionals perceive it clearly, as well as patients and decision-makers.…”

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confidence: 99%

Bioethics and healthcare policies. The benefit of using genetic tests of BRCA 1 and BRCA 2 in elderly patients

Fonseca

Caeiro

2020

Health Planning & Management

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This study focuses on the role of bioethics in designing public healthcare policies towards elderly patients with cancer. The general overview of public administration and healthcare approach to treatment. Interpretation of how the EU public administration faces the challenges of an ageing population and extended human longevity. The significant emotional impact a genetic cancer test holds, both in the patients and their families, is to be explained. From the bioethics' perspective, artificial intelligence and transhumanism are dangerous concerning its absence of boundaries. As a result of daily contact with cancer, we acknowledge the immediate and relevant impact science produces in a patient's life. We converge these subjects to the improvement of public policies and governmental efforts in increasing society's positive results.

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Use and Meaning of “Goals of Care” in the Healthcare Literature: a Systematic Review and Qualitative Discourse Analysis

Cited by 79 publications

References 40 publications

Evaluation of an End-of-Life Essentials Online Education Module on Chronic Complex Illness End-of-Life Care

Evaluation of an End-of-Life Essentials Online Education Module on Chronic Complex Illness End-of-Life Care

A Qualitative Exploration of Seriously Ill Patients’ Experiences of Goals of Care Discussions in Australian Hospital Settings

Bioethics and healthcare policies. The benefit of using genetic tests of BRCA 1 and BRCA 2 in elderly patients

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