Advance care planning documentation strategies; goals‐of‐care as an alternative to not‐for‐resuscitation in medical and oncology patients. A pre–post controlled study on quantifiable outcomes

Morgan, David; Eng, Derek; Higgs, Dominic; Beilin, Maria; Bulsara, Caroline; Wong, Milly; Angus, Louise; Waldron, Nicholas

doi:10.1111/imj.14048

Cited by 10 publications

(13 citation statements)

References 27 publications

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“…The goals‐of‐care (GOC) form is a resuscitation planning tool increasingly used in Australian hospitals to enable a discussion and an informed decision regarding limitations of resuscitation treatment 1, 2. The GOC form provides a chance for the patient (or substitute decision maker) to express their preferences on emergent treatment before the need to implement invasive or unwanted treatment arises,2, 3 additionally providing an opportunity for physicians to educate patients and their families regarding the utility and the realities of resuscitation efforts focussed on the individual's clinical situation 4…”

Section: Introductionmentioning

confidence: 99%

“…The GOC form is one of the predominant methods of inpatient resuscitation planning in Australia with a study showing improved rates of resuscitation planning form completion within the first 48 h of admission compared to the simpler, previously used Not‐For‐Resuscitation form 1. Structured similarly to the GOC form, and with more data available for review, the Acute Resuscitation Plan (ARP) form showed a rate of completion upwards of 60% in a subgroup of general medicine patients in a 2017 Australian study 8.…”

Section: Introductionmentioning

confidence: 99%

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Patient factors affecting the proper completion of a goals‐of‐care form in a general medicine hospital admission

Potenzi

Lim

2020

Internal Medicine Journal

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Background: The goals-of-care (GOC) form is a resuscitation planning tool used to document informed decisions tailored for individual patients admitted to hospital. Proper and timely completion of the GOC form is essential for its effective utility. Aims: To identify patient factors which may affect the timely discussion and documentation of GOC forms in patients admitted under a general medicine unit. Methods: We performed a cross-sectional study of 2589 patients during 3093 admissions under the general medicine unit from January 2017 to July 2017 at Dandenong Hospital in Melbourne, Australia. The main outcome was the proper completion of GOC forms, defined as GOC completion within 48 h of admission and adequate discussion with the patient or substitute decision maker. We used logistic regression to determine the association between the main outcome and several patient-related independent variables. Results: A GOC form was completed in 66% of all admissions but only 35% were considered properly completed (timely and adequately discussed). In the general multivariable logistic regression model, the variables associated with proper completion of GOC forms were age (OR = 1.58), English as the main spoken language (OR = 1.43) and readmissions (OR = 1.27). In patients 75 years and older, additional factors associated with proper GOC completion were confusion on admission (OR = 1.31) and number of comorbidities (OR = 1.27). Conclusions: The proper GOC form completion rates were suboptimal in general medicine admissions, particularly in younger patients with fewer comorbidities. Additional effort is needed to improve GOC completion in these patients and those whose primary spoken language is not English.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Patient factors affecting the proper completion of a goals‐of‐care form in a general medicine hospital admission

Potenzi

Lim

2020

Internal Medicine Journal

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“…13,30 A major barrier to successful SDM may be the clinicians' ability to elicit and recognise patient values, and integrate them into advice, conversations and decisions about treatment preferences and outcomes. Values, goals and preferences have been identified for patient groups 11,[31][32][33][34] and lay people 35 in various contexts, including end-oflife care, 11,12,36 consumer decision aids, 38 advance care planning, 33,38,39 GOC decisions, 2,5,33,40 integrative health care 41 and ICU settings.…”

Section: Relation To Previous Researchmentioning

confidence: 99%

Values, preferences and goals identified during shared decision making between critically ill patients and their doctors

Milnes¹,

Mantzaridis²,

Simpson³

et al. 2021

Critical Care and Resuscitation

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Objective: Examine values, preferences and goals elicited by doctors following goals-of-care (GOC) discussions with critically ill patients who had life-limiting illnesses. Design: Descriptive qualitative study using four-stage latent content analysis. Setting: Tertiary intensive care unit (ICU) in South Western Victoria. Participants: Adults who had life-limiting illnesses and were admitted to the ICU with documented GOC, between October 2016 and July 2018. Intervention: The iValidate program, a shared decision-making clinical communication education and clinical support program, for all ICU registrars in August 2015. Main outcome measures: Matrix of themes and subthemes categorised into values, preferences and goals. Results: A total of 354 GOC forms were analysed from 218 patients who had life-limiting illnesses and were admitted to the ICU. In the categories of values, preferences and goals, four themes were identified: connectedness and relational autonomy, autonomy of decision maker, balancing quality and quantity of life, and physical comfort. The subthemes — relationships, sense of place, enjoyment of activities, independence, dignity, cognitive function, quality of life, longevity and physical comfort — provided a matrix of issues identified as important to patients. Relationship, place, independence and physical comfort statements were most frequently identified; longevity was least frequently identified. Conclusion: Our analysis of GOC discussions between medical staff and patients who had life-limiting illnesses and were admitted to the ICU, using a shared decision-making training and support program, revealed a framework of values, preferences and goals that could provide a structure to assist clinicians to engage in shared decision making.

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“…The Goals‐of‐Care (GOC) form is a resuscitation planning tool used by most Australian hospitals to help guide discussions surrounding limitations of treatment and cardiopulmonary resuscitation 1,2 . The GOC form provides the patient and their substitute decision‐maker the opportunity to express preferences and for clinicians to individualise their resuscitation efforts focussed on the individual's choices and clinical situation.…”

Section: Introductionmentioning

confidence: 99%

Impact of electronic medical records and COVID‐19 on adult Goals‐of‐Care document completion and revision in hospitalised general medicine patients

Curtis

Nguyen

Rathnasekara

et al. 2022

Internal Medicine Journal

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Background Conversion from paper‐based to electronic medical records (EMR) may affect the quality and timeliness of the completion of Goals‐Of‐Care (GOC) documents during hospital admissions, and the COVID‐19 pandemic may have further impacted this. Aims Determine the impact of EMR and COVID‐19 on the proper completion of GOC forms, and the factors associated with inpatient changes in GOC. Methods We conducted a cross‐sectional study of adult general medicine admissions (Aug 2018‐Sep 2020) at Dandenong Hospital (Victoria, Australia). We used interrupted time series to model the changes in the rates of proper GOC completion (adequate documented discussion, completed ≤2 days) after the introduction of EMR and arrival of COVID‐19. Results We included a total of 5147 patients. The pre‐EMR GOC proper completion rate was 27.7% (overall completion, 86.5%). There was a decrease in the proper completion rate by 2.21% per month (95% CI: −2.83%, −1.58%) after EMR implementation despite an increase in overall completion rates (91.2%). The main reason for the negative trend was a decline in adequate documentation despite improvements in timeliness. COVID‐19 arrival saw a reversal of this negative trend, with proper completion rates increasing by 2.25% per month (95% CI: 1.35%, 3.15%) compared to the EMR period, but also resulted in a higher proportion GOC changes within 2 days of admission. Conclusion EMR improved the timeliness and overall completion rates of GOC at the cost of a lower quality of documented discussion. COVID‐19 reversed the negative trend in proper GOC completion but increased the number of early revisions. This article is protected by copyright. All rights reserved.

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Advance care planning documentation strategies; goals‐of‐care as an alternative to not‐for‐resuscitation in medical and oncology patients. A pre–post controlled study on quantifiable outcomes

Abstract: Despite an increased uptake of the GOC form, overall use remained low, written completion was poor, and most quantitative outcomes remained statistically unchanged. Further research is required before a wider GOC implementation can be supported in Australia's healthcare systems.

Cited by 10 publications

References 27 publications

Patient factors affecting the proper completion of a goals‐of‐care form in a general medicine hospital admission

Patient factors affecting the proper completion of a goals‐of‐care form in a general medicine hospital admission

Values, preferences and goals identified during shared decision making between critically ill patients and their doctors

Impact of electronic medical records and COVID‐19 on adult Goals‐of‐Care document completion and revision in hospitalised general medicine patients

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