Characterizing the Documentation of Time-Limited Trials in Goals of Care Notes.

Abstract

Time-limited trials (TLTs) are a collaborative plan among clinicians, patients, and surrogates to use life-sustaining therapy for a defined duration, after which the response to therapy informs the decision to either continue care focused on recovery or transition to comfort-focused care. To evaluate 1) how often goals of care (GOC) notes document TLT use; 2) what patient and clinician characteristics are associated with documented TLTs; and 3) how TLTs are described in GOC documentation. We conducted a retrospective cross-sectional study of documented standardized GOC template notes for seriously ill hospitalized adult patients across 21-hospitals between 2021 and 2023. We evaluated notes using descriptive statistics paired with qualitative, directed content analysis. Of 5475 GOC-template notes, we found reference to a TLT in 1% (n = 69/5475). Patients with TLT documentation were younger (72 vs 76 years, P = 0.0221), more likely to be self-pay or uninsured (7% vs. 2%, P = 0.0309), more likely to die in the hospital (54% vs. 27%, P < 0.0001) or discharge to a long-term acute care hospital (15% vs. 1%, P < 0.0001), when compared to patients with no such documentation. Notes with TLT documentation were more likely to document patient prognosis (94% vs. 79%, P = 0.0009) and less likely to document an accompanying change in patient code status (22% vs. 36%, P = 0.0117). TLTs are rarely documented within a standardized GOC note for seriously ill patients. Future research is needed to identify and address reasons for low documentation of TLTs in the EHR.