Communication about goals of care is a low-risk, high-value intervention for patients with serious and life-threatening illness; these discussions should begin early in the course of life-limiting illnesses. Ideally, communication about serious illness care goals should come from the patient’s primary clinician.
Early discussions about end-of-life care issues are associated with improved patient outcomes, including better quality of life, reduced use of futile treatments near death, and care more consistent with patients’ goals. This approach is also associated with improved family outcomes and reduced costs.
But dialogues about care goals are often conducted by physicians who do not know the patient, do not routinely deal with patients’ non-medical goals, and often fail to provide patients with sufficient information about prognosis to allow appropriate decisions. In addition, they tend to occur so late in the patient’s illness that their impact on care processes is reduced.
Conversations about serious illness care goals should be routinely integrated into clinical care processes by all physicians who care for this population of patients. Evidence is accumulating of the value of early discussions with patients about serious illness care goals as a key process for improving end-of-life outcomes.
The following steps are proposed to achieve an intervention with great potential for improving serious illness communication and care planning.
• Train clinicians to enhance competencies in conducting discussions.
• Identify patients at risk.
• Develop “triggers” to assure discussions take place at the appropriate time.
• Use a checklist or conversation guide to support clinicians and assure adherence to best practices.
• Provide a structured documentation template for serious illness care goals in the electronic health record.
• Measure performance.
See reference for more information.
Adapted from Bernacki R and Block SD. Communication about Serious Illness Care Goals: A Review and Synthesis of Best Practices. JAMA Internal Medicine 174(12). Internet. Available at https://www.researchgate.net/publication/267102032_Communication_About_Serious_Illness_Care_Goals_A_Review_and_Synthesis_of_Best_Practices. Accessed on January 2, 2020.<