Goals of care: a concept clarification

Stanek, Susan

doi:10.1111/jan.13243

Cited by 28 publications

(12 citation statements)

References 51 publications

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“…Patient comfort in our study seemed to constitute an implicit goal of care (GOC). According to Stanek (), GOCs are ideally established and made explicit through interaction between a patient and healthcare professionals, but are frequently taken for granted and not explicitly articulated. A critically ill patient's ability to express comfort needs may be impaired, hindering the establishment of explicit goals of comfort.…”

Section: Discussionmentioning

confidence: 99%

“Having the compass–drawing the map”: Exploring nurses’ management of pain and other discomforts during use of analgosedation in intensive care

2018

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Aim To explore the deliberation and enactment processes of nurses in relation to pain and other discomforts in the critically ill patients after the implementation of an analgosedation protocol. Background Nurses in intensive care units (ICU) face great challenges when managing pain and other discomforts and distinguishing between patients’ needs for analgesics and sedatives. An analgosedation protocol favouring pain management, light sedation and early mobilization was implemented in a university hospital ICU in Norway in 2014. Changing sedation paradigms resulting in an increasing number of awake patients during critical illness is expected to affect nursing practice. Design Exploratory, single‐unit study in a mixed adult ICU. Methods Data collection with participant observation and semi‐structured interviews in sixteen clinical situations in 2014 and 2015. Thirteen experienced certified critical care nurses were included. Thematic content analysis was conducted. Results An overall theme “ Having the compass–drawing the map ” emerged from the analysis. The protocol or strategy of analgosedation appeared to provide a direction for treatment and care, although requiring extensive interpretation of needs and individualization of care, often in challenging situations. The overall theme was abstracted from three themes: “Interpreting a complex whole,” “Balancing conflicting goals” and “Experiencing strain from acting across ideals.” Conclusion Nurses seem to attend adequately to patient pain, but the approach to discomforts other than pain appears unsystematic and haphazard. More explicit goals of care and strategies to handle discomfort as distinct from pain are needed. More research is needed to identify effective comfort measures for ICU patients.

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Section: Discussionmentioning

confidence: 99%

“Having the compass–drawing the map”: Exploring nurses’ management of pain and other discomforts during use of analgosedation in intensive care

2018

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“…Through this methodology, she defined ''goals of care'' as desired health expectations formulated through thoughtful interactions between the health care team and a human being. 16 Although Stanek's definition offers a potentially unified concept for ''goals of care,'' in our experience, there still is not a uniformly accepted definition that is applied reliably throughout clinical situations, nor a standardized process for establishing goals of care, which are essential in the current culture of inpatient practice involving multiple clinicians and care teams. Although having a standardized and uniformly accepted definition for ''goals of care'' certainly would not replace the need for direct communication between referring and consulting providers, we do believe it could potentially reduce communication misadventures between care services, or even with patients, knowing that time pressures to complete consultations efficiently Klement and Marks; Palliative Medicine Reports 2020, 1.1 http://online.liebertpub.com/doi/10.1089/pmr.2020.0063 and communication challenges in dealing with increasingly complex care teams are likely to continue in inpatient care environments.…”

Section: Case Analysismentioning

confidence: 99%

The Pitfalls of Utilizing “Goals of Care” as a Clinical Buzz Phrase: A Case Study and Proposed Solution

Klement

Marks

2020

Palliative Medicine Reports

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Assistance with discussing goals of care is one of the most common reasons clinicians seek out palliative care consultation. In practice though, the phrase ''goals of care'' is often utilized as a buzz phrase that lacks a shared understanding of its clinical relevance. We present a case example in which breakdowns in communication occurred between a patient and clinicians due to misunderstandings of the meaning of the phrase ''goals of care.'' Subsequently, we review the literature to propose a unified definition of ''goals of care'' in hopes to minimize differences in what this phrase implies in clinical practice. We also seek to introduce a standardized process for establishing goals of care that may offer a more reliable and measurable method to promote goalconcordant care.

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“…[1][2][3] In this paper, we define goals of care as a conversation between a health care provider and patient or surrogate to determine a patient's values, goals, and preferences related to treatment and end-oflife wishes in the context of medical illness. [4][5][6] While viewed separately, goals of care conversations, life-sustaining treatment orders, 7 and advance care planning 8 all draw on conversations about patient goals and seek to foster goal-concordant care. Diverse initiatives promoting such conversations include elements of communication training to physicians, physician trainees, and advanced practice providers 1,9,10 and expanded training to nurses and lay health workers.…”

Section: Introductionmentioning

confidence: 99%

Exploring expanded interdisciplinary roles in goals of care conversations in a national goals of care initiative: A qualitative approach

et al. 2021

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Background: The United States Veterans Health Administration National Center for Ethics in Health Care implemented the Life-Sustaining Treatment Decisions Initiative throughout the Veterans Health Administration health care system in 2017. This policy encourages goals of care conversations, referring to conversations about patient’s treatment and end-of-life wishes for life-sustaining treatments, among Veterans with serious illnesses. A key component of the initiative is expanding interdisciplinary provider roles in having goals of care conversations. Aim: Use organizational role theory to explore medical center experiences with expanding interdisciplinary roles in the implementation of a goals of care initiative. Design: A qualitative thematic analysis of semi-structured interviews. Setting/participants: Initial participants were recruited using purposive sampling of local medical center champions. Snowball sampling identified additional participants. Participants included thirty-one interdisciplinary providers from 12 geographically diverse initiative pilot and spread medical centers. Results: Five themes were identified. Expanding provider roles in goals of care conversations (1) involves organizational culture change; (2) is influenced by medical center leadership; (3) is supported by provider role readiness; (4) benefits from cross-disciplinary role agreement; and (5) can “overwhelm” providers. Conclusions: Organizational role theory is a helpful framework for exploring interdisciplinary roles in a goals of care initiative. Support and recognition of provider role expansion in goals of care conversations was important for the adoption of a goals of care initiative. Actionable strategies, including multi-level leadership support and the use of interdisciplinary champions, facilitate role change and have potential to strengthen uptake of a goals of care initiative.

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Goals of care: a concept clarification

Cited by 28 publications

References 51 publications

“Having the compass–drawing the map”: Exploring nurses’ management of pain and other discomforts during use of analgosedation in intensive care

“Having the compass–drawing the map”: Exploring nurses’ management of pain and other discomforts during use of analgosedation in intensive care

The Pitfalls of Utilizing “Goals of Care” as a Clinical Buzz Phrase: A Case Study and Proposed Solution

Exploring expanded interdisciplinary roles in goals of care conversations in a national goals of care initiative: A qualitative approach

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