Assistance with discussing goals of care is one of the most common reasons clinicians seek out palliative care consultation. Goal-concordant care has been suggested as clinical care that helps a patient reach an identifiable goal and respects any treatment preferences or limitations the patient has placed on his or her clinical care.
But determining and measuring if outcomes are concordant with patients' goals are difficult.
To systematize communication between interdisciplinary teams, patients, and surrogates, a two-step “goals-of-care” process could be uniform throughout health care systems.
Identifying the primary intent of medical interventions (¿shared understanding of the primary aim of treatment?
• To cure
• To prolong life
• To focus on comfort
Recommending practices personalized by patient values and the underlying medical realities (¿practices according to patient goals?
• Functional: improve or maintain current functional status or mobility.
• Survival: avoid premature death, maximize dignity, and/or quality of life.
• Family: attend an event, leave a legacy, avoid burden on family.
• Mentation: maintain cognitive status or maximize alertness.
• Psychosocial: make peace with family/faith, complete a will.
It is a repetitive and smart process between provider and patient, which involves assessing the patient's hopes, fears, worries, and sense of purpose through illness.
Measurement of goal-concordant care is important for maintaining high-quality care across health care systems. This also could turn into success with attaining goal-concordant care, as both generalist and specialist providers may be more likely to participate in a simplified process that they can conceptualize and follow.
See reference for more information.
Adapted from Klement A, Marks S. The pitfalls of utilizing “goals of care” as a clinical buzz phrase: a case study and proposed solution. Palliative Medicine Reports, vol. 1. Internet. Available at https://www.liebertpub.com/doi/full/10.1089/pmr.2020.0063 Accessed on November 6, 2020.