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, while respecting treatment preferences or limitations the patient has placed on their clinical care.
But it is difficult to determine, and measure, if outcomes are concordant with patients' goals.
To make communication between interdisciplinary teams, patients, and surrogates systematic, a two-step “goals-of-care” process could be unified throughout health care systems.
Step 1. Identifying the primary intent of medical interventions (
is there shared understanding of the primary aim of treatment?)
• To cure
• To prolong life
• To focus on comfort
Step 2. Recommending practices personalized by patient values and the underlying medical realities (
are practices in line with 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 process between provider and patient that is repeated, and 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 could also turn into broader 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.
