A Prospective Intervention to Increase Goals of Care Conversations with Hospitalized Patients Suffering Severe Stroke (Sci204)

• Published in: Journal of pain and symptom management Vol. 65; no. 5; pp. e641 - e642
• Main Authors: Comer, Amber R., Sinha, Shilpee, Tormoehlen, Laura, Fettig, Lyle, Bartlett, Stephanie L., D'Cruz, Lynn E., Kassab, Veronica R., Rivera-Cordova, Xochitl G., Anderson, Leigh, Schroeder, Lindsay, Slaven, James, Torke, Alexia
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-05-2023
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2023.02.254

1. Through analyzing the process and results of an intervention to increase documented goals-of-care conversations, participants will self-report the ability to apply lessons learned to their clinical practice.
2. Participants will self-report the ability to define goals-of-care conversation domains and the ability to demonstrate and integrate these domains within clinical practice.
Goals of care conversations (GOCC) are essential for patient centered care.
To determine feasibility and acceptability of using a GOCC template within the electronic medical record (EMR) to increase documented GOCC.
A prospective mixed-methods, pre-post interventional study was conducted for 8 weeks in a large academic hospital. Neurologists were provided training on use of a GOCC template within the EMR. Neurologists were texted a prompt to use the GOCC template on all severe stroke patients (NIHSS≥10) on hospital days 1, 5, and 8. Patient demographic, clinical characteristics, and outcomes were collected. Use of the template was collected during the intervention. GOCC documented within patient notes in the EMR were collected 8 weeks prior to and during the intervention. GOCC domains included prognosis, treatment plan, quality of life, patient preferences values, and goals, and establishing treatment goals. At the conclusion of the intervention, neurologists were qualitatively interviewed regarding their experience. Qualitative interviews were coded using thematic analysis.
The intervention group included n=39 patients and the pre-intervention group included n=43 patients. There were no statistically significant differences in demographic and clinical characteristics between cohorts. No neurologists used the GOCC template during the intervention period. Documented GOCC by neurologists within patient notes did not significantly differ between the pre and post intervention cohorts (35% v. 36%, p=.92). Post-intervention, n=8 neurologists were interviewed. Neurologists indicated a lack of time, confusion about responsibility to engage in GOCC, and another service having GOCC first as the primary reasons for not using the GOCC template.
Prompts to encourage the use of a GOCC template neither increased use of the template or other documented GOCC in the EMR.
Further research is needed to determine ways to increase documented GOCC within the EMR.