Unit
- Definition: A goals of care discussion is a structured conversation between healthcare providers, patients, and families to clarify the patient's values, preferences, and treatment goals. It is distinct from advance care planning, which focuses on future incapacity, whereas goals of care applies to current and anticipated medical decisions.
- Primary purpose: Align medical treatment with what matters most to the patient, improving satisfaction and reducing unwanted or futile interventions. This alignment is associated with better quality of life and lower healthcare utilization in serious illness.
- Clinical contexts: Goals of care discussions are essential in serious or chronic illness, end-of-life care, surgery planning, and any major treatment decision. They are not limited to palliative care but are relevant across all specialties.
- Administrative role: Healthcare administrators design workflows, train staff, and create policies that enable timely and consistent goals of care conversations. They ensure documentation systems capture these discussions for care coordination.
- Outcome measurement: Organizations track metrics such as documentation rates, patient-reported alignment, and surrogate decision-maker satisfaction to evaluate the effectiveness of goals of care programs.
- Regulatory context: Medicare and other payers require shared decision making for certain procedures, and accreditation bodies like The Joint Commission expect documented goals of care for patients with serious illness.
- Ethical foundation: Goals of care discussions respect patient autonomy and promote beneficence by ensuring treatments align with patient values. They also support non-maleficence by avoiding unwanted interventions.
- Care coordination: When goals are documented and shared across the care team, transitions between settings (hospital to home, or to palliative care) become smoother and more patient-centered.
- Communication frameworks: Structured tools like the SPIKES protocol and the REMAP conversation guide provide clinicians with step by step approaches to initiating and navigating goals of care discussions. These frameworks help standardize quality and reduce clinician anxiety during emotionally challenging conversations.
- Patient and family engagement: Goals of care discussions actively involve patients and their chosen family members or surrogates in a shared decision making process. This engagement fosters trust, reduces decisional conflict, and ensures that cultural, spiritual, and personal values are respected alongside clinical recommendations.
- Interdisciplinary collaboration: Effective goals of care programs rely on input from physicians, nurses, social workers, chaplains, and other allied health professionals. Each discipline contributes unique perspectives on patient values, psychosocial barriers, and practical care options, resulting in more comprehensive and realistic care plans.
Scope of Practice
Role: Healthcare Administrator in a Hospital System
Within scope:
- Developing institutional policies for goals of care discussions.
- Training clinical staff on communication frameworks and documentation tools.
- Auditing documentation compliance and providing feedback to teams.
- Coordinating with IT to integrate goals of care templates into electronic health records.
- Facilitating interdisciplinary committee meetings to review program outcomes.
Outside scope:
- Conducting goals of care conversations with patients directly, unless trained and authorized.
- Making medical decisions or interpreting patient values for clinicians.
- Providing legal advice regarding advance directives or surrogate consent.
- Altering treatment plans without clinical team input.
- Releasing patient information without proper authorization.
Quick Revision
- Goals of care discussions align medical treatment with patient values and preferences.
- Healthcare administrators enable these conversations through policy, training, and documentation systems.
- Ethical principles of autonomy, beneficence, and non-maleficence underpin goals of care.
- Regulatory and accreditation bodies increasingly require documentation of goals of care.