Documented Goals of Care Conversations with Hospitalized Patients After Severe Stroke (GP715)

• Published in: Journal of pain and symptom management Vol. 63; no. 6; p. 1120
• Main Authors: Comer, Amber, Creutzfeldt, Claire, D'Cruz, Lynn, Bartlett, Stephanie, Holloway, Robert, Torke, Alexia, Petras, Laura, Williams, Linda
• Format: Journal Article
• Language: English
• Published: Madison Elsevier Limited 01-06-2022
• Subjects: Best practice; Caregivers; Goal setting; Hospitalization; Life goals; Medical records; Multivariate analysis; Patients; Quality of life; Severity; Stroke; Suffering; Timing; Treatment preferences
• ISSN: 0885-3924
• DOI: 10.1016/j.jpainsymman.2022.04.106

Outcomes. 1. Understand the prevalence, frequency, timing, and content of a goals-of-care conversation 2. Learn best practices in goals-of-care conversation documentation Importance. Setting goals of care is paramount in order for patients suffering severe stroke and their caregivers to make effective medical decisions. Objective(s). This study sought to determine the prevalence and characteristics associated with having a documented goals-of-care conversation (GOCC) after severe stroke. Method(s). Among a retrospective cohort of patients with severe ischemic stroke (NIH Stroke Scale Score, NIHSS, ≥10) from 4 hospitals, we reviewed the medical record to assess GOCCs. GOCCs were defined as documented conversations that included one or more of the following: prognostic information, treatment plan, patient preferences and values, quality of life, and establishing goals. We determined prevalence, frequency, timing, and content of GOCCs. Additionally, we obtained information on treatment utilization and outcomes. Results. Among 1,305 patients, 26% (n = 345) had at least one documented GOCC after severe stroke. Treatment plan was most commonly discussed during the first GOCC (n = 207, 60% of first conversations). Median day for first GOCC was on hospital day 1. One in four first GOCCs occurred on or after hospital day 7. In multivariate analysis, being male (p = .02, OR .75) and having a moderately high (p = .02, OR .94) or very high NIHSS (p = .01, OR 1.99) were each associated with having a GOCC. Patients with GOCCs were more likely to be moved to comfort measures only (p > .01). In bivariate analysis, code status change was associated with GOCC (p > .01) and discharge location (p > .01). Conclusion(s). After severe stroke, only 26% of patients had a documented GOCC in their medical record. Very few GOCCs documented a discussion of quality of life or patient preferences, values, and goals. Impact. There is a need for earlier, more frequent, and better quality GOCCs during hospitalization for patients suffering severe stroke.