Guided Goals of Care Conversations Reveal Evolving, Personalized Priorities.

Abstract

Understanding the dynamics of goals of care conversations between patients, nurses, and social workers in an outpatient setting may reveal benefits and opportunities for improvement. Assess goals of care conversations between the healthcare team and Veterans with chronic heart and lung diseases to better understand patient's perspectives on care goals. In the intervention arm of a clinical trial, a nurse or social worker conducted telephone-based outpatient goals of care conversations using a semi-structured, seven-question communications guides. Inductive thematic qualitative analysis was applied to audio recordings of 27 conversations. Three independent coders iteratively developed emerging themes, which were further refined through team consensus. Participants mean age was 66 years (SD 6), 93% male, and 70% self-identified non-Hispanic white. The mean length of conversation was 51 minutes (SD 14). Four themes emerged: (1) participants appreciated the discussions and found them meaningful; (2) participant readiness to engage varied and often evolved; (3) goals were highly individualized and ranged from health care to personal; and (4) participants confused medical and legal terminology. In goals of care conversations with Veterans with cardiopulmonary disease, goals evolved, revealing personalized insights that could shape their treatment plans. Variations in participant readiness and challenges in terminology emerged and progressed within single encounters.