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

Abstract

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.

Supporting the Heterogeneous and Evolving Treatment Preferences of Patients With Heart Failure Through Collaborative Home‐Based Palliative Care

“…Fourth, goals of care are more than health care decisions and encompass the many individualized goals a person may have as their disease worsens rather than simplified questions about treatments that prioritize quantity versus QOL. 44 , 45 Fifth, our findings demonstrate that treatment preferences among people with HF at the end of life are dynamic. The associated effects of earlier and more frequent assessments of these preferences on end‐of‐life care outcomes remain unknown.…”

Identification of Palliative Care Needs and Mental Health Outcomes Among Family Members of Patients With Severe Acute Brain Injury

“…The concept of goals of care may not be as clear to patients and family members. 25 Asking clinicians to identify needs during morning work rounds did not appear to be associated with poor psychological outcomes, but it was associated with other concerning outcomes, including goal-discordant care and decisional regret. However, we only analyzed the SuPPOrTT checklist completed on the day of enrollment, and needs or awareness of needs may have been different on other days.…”

“…On the other hand, family members rarely identified a need to readdress goals of care, while this was identified by one-quarter of clinician teams. The concept of goals of care may not be as clear to patients and family members …”

Video Intervention and Goals-of-Care Documentation in Hospitalized Older Adults

“…3,4 Goals-of-care communication has been associated with less intensive medical care near death; reductions in stress, anxiety, and depression in surviving relatives; improvements in patient and family satisfaction; and receipt of goalconcordant care. [5][6][7][8][9][10][11][12] A failure to provide care aligned with patients' preferences is a medical error. 1 Despite the benefits of GOC communication, clinicians often feel poorly prepared or lack sufficient time to engage in discussions about GOC, [13][14][15] and patients and families often have difficulty understanding such conversations.…”

“…Goals-of-care (GOC) communication is not limited to patients facing serious or life-threatening illnesses; rather, it can support adults regardless of age or health status in sharing their preferences, values, and goals for medical care . Goals-of-care communication has been associated with less intensive medical care near death; reductions in stress, anxiety, and depression in surviving relatives; improvements in patient and family satisfaction; and receipt of goal-concordant care . A failure to provide care aligned with patients’ preferences is a medical error …”