Katharine Secunda1,2, M Jeanne Wirpsa3, Kathy J Neely1,4, Eytan Szmuilowicz1,4, Gordon J Wood1,4, Ellen Panozzo3, Joan McGrath3, Anne Levenson1,2, Jonna Peterson1,5, Elisa J Gordon1,6,7,8, Jacqueline M Kruser9,10,11. 1. Northwestern University Feinberg School of Medicine, 633 N. St. Clair Street, 20th Floor, Chicago, IL, 60611, USA. 2. Department of Medicine, Division of Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, USA. 3. Northwestern Memorial Hospital, Chicago, IL, USA. 4. Department of Medicine, Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA. 5. Galter Health Sciences Library and Learning Center, Northwestern University Feinberg School of Medicine, Chicago, USA. 6. Department of Surgery, Division of Transplantation, Northwestern University Feinberg School of Medicine, Chicago, USA. 7. Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, USA. 8. Center for Bioethics and Medical Humanities, Northwestern University Feinberg School of Medicine, Chicago, USA. 9. Northwestern University Feinberg School of Medicine, 633 N. St. Clair Street, 20th Floor, Chicago, IL, 60611, USA. jacqueline.kruser@northwestern.edu. 10. Department of Medicine, Division of Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, USA. jacqueline.kruser@northwestern.edu. 11. Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, USA. jacqueline.kruser@northwestern.edu.
Abstract
BACKGROUND: The specific phrase "goals of care" (GOC) is pervasive in the discourse about serious illness care. Yet, the meaning of this phrase is ambiguous. We sought to characterize the use and meaning of the phrase GOC within the healthcare literature to improve communication among patients, families, clinicians, and researchers. METHODS: A systematic review of the English language healthcare literature indexed in MEDLINE/PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus was performed in October of 2018. We searched for all publications with the exact phrase "goals of care" within the title or abstract; no limitations on publication date or format were applied; conference abstracts were excluded. We used qualitative, discourse analysis to identify key themes and generate an operational definition and conceptual model of GOC. RESULTS: A total of 214 texts were included in the final analysis. Use of GOC increased over time with 87% of included texts published in the last decade (2009-2018). An operational definition emerged from consensus within the published literature: the overarching aims of medical care for a patient that are informed by patients' underlying values and priorities, established within the existing clinical context, and used to guide decisions about the use of or limitation(s) on specific medical interventions. Application of the GOC concept was described as important to the care of patients with serious illness, in order to (1) promote patient autonomy and patient-centered care, (2) avoid unwanted care and identify valued care, and (3) provide psychological and emotional support for patients and their families. DISCUSSION: The use of the phrase "goals of care" within the healthcare literature is increasingly common. We identified a consensus, operational definition that can facilitate communication about serious illness among patients, families, and clinicians and provide a framework for researchers developing interventions to improve goal-concordant care.
BACKGROUND: The specific phrase "goals of care" (GOC) is pervasive in the discourse about serious illness care. Yet, the meaning of this phrase is ambiguous. We sought to characterize the use and meaning of the phrase GOC within the healthcare literature to improve communication among patients, families, clinicians, and researchers. METHODS: A systematic review of the English language healthcare literature indexed in MEDLINE/PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus was performed in October of 2018. We searched for all publications with the exact phrase "goals of care" within the title or abstract; no limitations on publication date or format were applied; conference abstracts were excluded. We used qualitative, discourse analysis to identify key themes and generate an operational definition and conceptual model of GOC. RESULTS: A total of 214 texts were included in the final analysis. Use of GOC increased over time with 87% of included texts published in the last decade (2009-2018). An operational definition emerged from consensus within the published literature: the overarching aims of medical care for a patient that are informed by patients' underlying values and priorities, established within the existing clinical context, and used to guide decisions about the use of or limitation(s) on specific medical interventions. Application of the GOC concept was described as important to the care of patients with serious illness, in order to (1) promote patient autonomy and patient-centered care, (2) avoid unwanted care and identify valued care, and (3) provide psychological and emotional support for patients and their families. DISCUSSION: The use of the phrase "goals of care" within the healthcare literature is increasingly common. We identified a consensus, operational definition that can facilitate communication about serious illness among patients, families, and clinicians and provide a framework for researchers developing interventions to improve goal-concordant care.
Authors: Lauris C Kaldjian; Ann E Curtis; Laura A Shinkunas; Katrina T Cannon Journal: Am J Hosp Palliat Care Date: 2008 Dec-2009 Jan Impact factor: 2.500
Authors: Leslie P Scheunemann; Thomas V Cunningham; Robert M Arnold; Praewpannarai Buddadhumaruk; Douglas B White Journal: Crit Care Med Date: 2015-04 Impact factor: 7.598
Authors: Emily K Chen; Catherine Riffin; M Cary Reid; Ronald Adelman; Marcus Warmington; Sonal S Mehta; Karl Pillemer Journal: J Palliat Med Date: 2014-06-02 Impact factor: 2.947
Authors: David Hui; Maxine De La Cruz; Masanori Mori; Henrique A Parsons; Jung Hye Kwon; Isabel Torres-Vigil; Sun Hyun Kim; Rony Dev; Ronald Hutchins; Christiana Liem; Duck-Hee Kang; Eduardo Bruera Journal: Support Care Cancer Date: 2012-08-31 Impact factor: 3.603
Authors: Frank D Ferris; Eduardo Bruera; Nathan Cherny; Charmaine Cummings; David Currow; Deborah Dudgeon; Nora Janjan; Florian Strasser; Charles F von Gunten; Jamie H Von Roenn Journal: J Clin Oncol Date: 2009-05-18 Impact factor: 44.544
Authors: Jacqueline M Kruser; Brian T Benjamin; Elisa J Gordon; Kelly N Michelson; Richard G Wunderink; Jane L Holl; Margaret L Schwarze Journal: Crit Care Med Date: 2019-06 Impact factor: 7.598
Authors: Daniel Hong; Lauren C Das; Ellen Daily; Stacie K Levine; Olwen M Hahn; Stanley L Liauw; Daniel W Golden; Christina H Son Journal: Support Care Cancer Date: 2021-05-25 Impact factor: 3.603
Authors: Alison M Uyeda; J Randall Curtis; Ruth A Engelberg; Lyndia C Brumback; Yue Guo; James Sibley; William B Lober; Trevor Cohen; Janaki Torrence; Joanna Heywood; Sudiptho R Paul; Erin K Kross; Robert Y Lee Journal: J Pain Symptom Manage Date: 2022-02-16 Impact factor: 5.576
Authors: Carolyn Steele Gray; Agnes Grudniewicz; Alana Armas; James Mold; Jennifer Im; Pauline Boeckxstaens Journal: Int J Integr Care Date: 2020-11-04 Impact factor: 5.120
Authors: Kristen K McNiff; Michael A Caligiuri; Nancy E Davidson; William Farrar; Richard I Fisher; Laurie H Glimcher; Rodney B Hanners; Patrick Hwu; Candace S Johnson; Peter W T Pisters; Craig B Thompson; Akhila S Reddy; Barbara Jagels; Jack A Kolosky; Thomas Ross; Karen Bird Journal: Oncologist Date: 2021-06-15