This week’s piece breaks it down: power literacy, default settings, solidarity, trauma-informed choices, and the workflows that make clinician-guided care ethical instead of coercive.
#GoalsOfCare #AdvanceCarePlanning #HealthJustice

Evaluation of a Novel Goals-of-Care Discussion Priming Tool (MyCare) in Inpatient General Internal Medicine Ward Settings: #feasibility, Acceptability, and #usability Study Background: For patients who are seriously ill, conversations about prognosis, values, and goals can improve person-centered care; however, these conversations do not occur consistently. Objective: We aimed to develop an online, interactive goals-of-care discussion priming tool called MyCare to facilitate conversations about patient goals among physicians, patients, and family members. Our objective was to determine the #feasibility, acceptability, and #usability of MyCare for patients who are seriously ill in hospitals. Methods: We conducted a mixed methods study on internal medicine wards with patients who were seriously ill at 2 hospitals. Participants completed MyCare with a research assistant in their hospital room, and their responses were sent to their attending physician team. Patients, family members, and physicians participated in semistructured interviews to assess advance care planning engagement, #usability, and acceptability. Patients also completed the System #usability Scale, the eHealth literacy scale, and survey questions about acceptability. Results: Patients took a median time of 32 (IQR 21-43) minutes to complete MyCare, with a range of 12 to 101 minutes. The mean eHealth literacy score was 56 out of 100. In total, 19 (76%) out of 25 patients indicated that MyCare helped them think about and understand what was most important to them, and 16 (64%) stated that MyCare helped them think about the type of care they would want if their illness progressed. The mean advance care planning engagement scores on a 5-point scale before and after MyCare were 4.11 (SD 0.77) and 4.20 (SD 0.74), respectively (mean difference 0.09, 95% CI –0.08 to 0.34; P=.22). After completing MyCare, 16% (4/25) of the patients reported feeling more prepared to talk to their medical decision-maker about the type of care they would want if they were very sick or near the end of life, and none felt less prepared. The most useful elements for patients were (1) clarifying goals and wishes for care, (2) identifying people who supported them, and (3) having a resource to facilitate conversations with their families. The most useful elements for physicians were patients’ prioritized values and goals. Conclusions: MyCare and similar tools will be more usable and acceptable if they are short and simple, focus on shared physician-patient priorities, and empower patients to advocate for their own goals.

JMIR Formative Res: Evaluation of a Novel Goals-of-Care Discussion Priming Tool (MyCare) in Inpatient General Internal Medicine Ward Settings: #feasibility, Acceptability, and #usability Study #HealthCare #PatientCentered #GoalsOfCare #MyCare #InternalMedicine

Ah yes, because #AI is going to identify polymicrobial abdominal sepsis in an advanced GI cancer patient by its nonexistent hands palpating Murphy's sign, have a difficult #goalsofcare discussion, transition to #comfortcare, and ensure a caring #death. Who needs a human for such things.

Have we had a GOC conversation with America yet?

#goalsofcare #medicaidmatters #endstagecapitalism #DNR

I’ve learned not to judge what quality of life means for others.

Some choose aggressive treatment despite slim odds and real suffering—not out of denial, but because they’re holding on for something that matters:
a daughter’s wedding,
a grandchild’s birth,
a final reunion.

#Geriatrics #GoalsOfCare

Everyone should be discussing this with everyone.
It’s too late when the plastic tube is in your trachea & compressions ongoing.
#GoalsOfCare #ICU

Having hard conversations: Advance care planning, serious illness conversations, & goals of care discussions with oncology patients
www.cfp.ca/content/71/2...

This paper addresses some challenges navigating from ACP to get to goal-concordant care, improved QoL

#palliative #goalsofcare #ACP

14 yrs ago I cared for a pt shocked 28x by her ICD. Aphasic from a recent CVA, no one knew. I made it my mission to ensure ICDs are aligned w/ pts’ #goalsofcare. Proud to share some of our work.
ahajrnls.org/3PTGy7A
#humanityinmedicine
#humanityfirst
#palliativecare
#cardiology

Patient Preferences for Code Status Discussions: A Randomized Trial of Information- vs. Patient Values-Centered Frameworks

How do patients want their #CodeStatus discussed? In a new randomized study, most supported a values-centered approach, which focuses on what the clinician recommends based on a discussion of their #GoalsOfCare.


Read in #JGIM:

Psychiatric Goals of Care at the End of Life: A Qualitative Analysis of Medical Records at a Geriatric Psychiatric Outpatient Clinic Objectives: Person-centered care emphasizes patient choice and autonomy and is considered an important means for improving the quality of care and quality of life for older adults with multiple chron...

JUST PUBLISHED | Psychiatric #GoalsOfCare at the end of life: A qualitative analysis of medical records at a #Geriatric psychiatric outpatient clinic 🧠

Interesting how the #goalsofcare section is always listed last in the assessment and plan. #itshouldbethefirst #ICUnephrologythoughts