Do We Know What We Mean? An Examination of the Use of the Phrase "Goals of Care" in the Literature.

Abstract

<b><i>Background:</i></b> There is no consensus approach to describe the process or components of goals of care (GOC) conversations. <b><i>Objective:</i></b> The objective was to review the utilization of the phrase "GOC" in PubMed-indexed literature to contextualize the use of the phrase. Secondary aim was to describe the use of this phrase within journals focused on palliative care. <b><i>Methods:</i></b> A review of articles in the PubMed-indexed literature published during a single year utilizing the phrase "goals of care." <b><i>Results:</i></b> A total of 191 articles were reviewed after exclusions. Few articles included an operant definition for GOC (<i>n</i> = 27, 14%). It was often used to describe conversations focused on determining intent for treatment (<i>n</i> = 57, 30%), talks about death or dying (<i>n</i> = 52, 27%), or simply vague discussions (<i>n</i> = 39, 20%). The agenda was focused on the outcomes of the conversation (<i>n</i> = 169, 88%) compared with factors such as hopes, worries, values, and personhood (<i>n</i> = 22, 12%). The majority did not utilize the phrase "palliative care" (<i>n</i> = 77, 40%); those who did frequently used "palliative care" incorrectly (<i>n</i> = 72, 38%). <b><i>Conclusions:</i></b> The definition of the phrase GOC is most often assumed with its context centered on the needs of the health care system and linked to a specific medical topic. It is most commonly used to describe determinations of the patient's therapy intent, second most commonly to describe end-of-life conversations. The use of the phrase GOC within the palliative literature does not differ notably from its use in the broader literature.