The Duality of Goals of Care Language: A Qualitative Focus Group Study With Frontline Clinicians

Context. The phrase goals of care (GOC) is common in serious illness care, yet it lacks clarity and consistency. Understanding how GOC is used across healthcare contexts is an opportunity to identify and mitigate root causes of serious illness miscommunication. Objectives. We sought to characterize frontline palliative and critical care clinicians' understanding and use of the phrase GOC in clinical practice.Methods. We conducted a secondary qualitative thematic analysis of focus group transcripts (n = 10), gathered as part of a parent study of care delivery for patients with respiratory failure. Participants (n = 59) were members of the palliative and critical care interprofessional teams at two academic medical centers.Results. Clinicians primarily use GOC as a shorthand signal among team members to indicate a patient is nearing the end of life. This signal can also indicate conflict with patients and families when clinicians' expectations-typically an expected transition toward a different type of care-are not met. Clinicians distinguish their clinical use of GOC from an ideal meaning of the phrase, which is broader than end of life and focused on patients' values. Palliative care specialists encourage other clinicians to shift toward the ideal GOC concept in clinical practice.Conclusion. Frontline palliative and critical care clinicians understand a duality in GOC, as an idealized concept and as an expeditious signal for clinical care. Our findings suggest ambiguous phrases like GOC persist because of unmet needs for better ways to discuss and address diverse and complex priorities for patients with serious illness. J Pain Symptom Manage 2023;66: e658-e665.(c) 2023 The Authors. Published by Elsevier Inc. on behalf of American Academy of Hospice and Palliative Medicine. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)

Automated summary

This study aimed to understand the understanding and use of the phrase goals of care (GOC) among frontline palliative and critical care clinicians. The findings showed that clinicians primarily use GOC as a shorthand signal for indicating patients approaching end of life, and it could also indicate conflicts with patients and families. Palliative care specialists encourage other clinicians to focus more on the ideal meaning of GOC, which is broader and focused on patients' values.