JOURNAL OF PALLIATIVE MEDICINE Volume 18, Number 2, 2015 ª Mary Ann Liebert, Inc. DOI: 10.1089/jpm.2014.0394
Present Planning versus Future Planning: We Need a Shift Toward Goals of Care Education for Physicians Yuya Hagiwara, MD,1 Deborah Villarreal MD,1,2 and Sandra Sanchez-Reilly, MD, FAAHPM1,2
Dear Editor: One focus of education in palliative care has been advance directives, which is future oriented.1,2 Determining goals of care with patients and families is present directed. Discussing goals as early as possible in the course of illness ensures that the patient will receive treatments consistent with his or her goals.3 Our impression has been that goals of care are being neglected in trainee discussions with patients. We argue that goals of care discussion deserves more of our interdisciplinary attention. To assess this impression we evaluated house staff documentation of goals of care in the charts of patients during their hospital stay in our Acute Care for the Elderly (ACE) unit.
house staff regarding goals of care. Further, these were only documented for comfort care or hospice. Since this study was conducted in a single site, there is need for a broader study to examine if this discrepancy is typical. Next Steps
We are currently developing structured curricula on goals of care: importance, how to conduct, and how to document. The curriculum will be participatory so that the trainees will gain both confidence and competence in their skills in this arena. It is our intention to conduct a follow-up review of charts in 2015 to determine the impact of our new training efforts.
Methods
References
We conducted a retrospective chart review of patients aged 65 and older admitted to our ACE unit during August and September of 2013. Charts were evaluated for house staff documentation regarding code status and goals of care. We reviewed all history and physicals, progress notes, and discharge summaries and searched for the following literature-based framework of goals:4 (1) be cured, (2) live longer, (3) improve or maintain function/quality of life, (4) be comfortable, (5) achieve life goals, (6) provide support for family/caregiver, and (7) other.
1. Toraya C: Evaluation of advance directives video education for patients. J Palliat Med 2014;17:942–946. 2. Levi BH, Wilkes M, Der-Martirosian C, et al.: An interactive exercise in advance care planning for medical students. J Palliat Med 2013;16:1523–1527. 3. Emanuel LL, Hauser JM, Bailey FA, et al.: Module 7: Goals of care, in the education in palliative and end-of-life care (EPEC) curriculum. Chicago, IL: EPEC, 2011. 4. Kaldjian LC, Curtis AE, Shinkunas L, Cannon KT: Goals of care toward the end of life: A structured literature review. Am J Hosp Palliat Care 2009;25:501–511.
Results
Of 77 patients included, mean age was 81.4. Results indicated that 97.4% (75/77) patients had their code status documented, while only 15.6% (12/77) had goals of care documented. Goals of care documentation were present only when patients elected comfort care or hospice. We were not able to identify documentation of other possible goals for health care.
Address correspondence to: Yuya Hagiwara, MD University of Texas Health Science Center at San Antonio Division of Geriatrics, Gerontology and Palliative Medicine 7703 Floyd Curl Drive MSC 7875 San Antonio, TX 78229
Discussion
Results suggest that although the rate of code status documentation was high, there was limited documentation by
E-mail: [email protected]
1 Division of Geriatrics, Gerontology and Palliative Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas. 2 Geriatric Research Education Clinical Center, South Texas Veterans Health Care System, San Antonio, Texas.
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Copyright of Journal of Palliative Medicine is the property of Mary Ann Liebert, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Present Planning versus Future Planning: We Need a Shift Toward Goals of Care Education for Physicians Yuya Hagiwara, MD,1 Deborah Villarreal MD,1,2 and Sandra Sanchez-Reilly, MD, FAAHPM1,2
Dear Editor: One focus of education in palliative care has been advance directives, which is future oriented.1,2 Determining goals of care with patients and families is present directed. Discussing goals as early as possible in the course of illness ensures that the patient will receive treatments consistent with his or her goals.3 Our impression has been that goals of care are being neglected in trainee discussions with patients. We argue that goals of care discussion deserves more of our interdisciplinary attention. To assess this impression we evaluated house staff documentation of goals of care in the charts of patients during their hospital stay in our Acute Care for the Elderly (ACE) unit.
house staff regarding goals of care. Further, these were only documented for comfort care or hospice. Since this study was conducted in a single site, there is need for a broader study to examine if this discrepancy is typical. Next Steps
We are currently developing structured curricula on goals of care: importance, how to conduct, and how to document. The curriculum will be participatory so that the trainees will gain both confidence and competence in their skills in this arena. It is our intention to conduct a follow-up review of charts in 2015 to determine the impact of our new training efforts.
Methods
References
We conducted a retrospective chart review of patients aged 65 and older admitted to our ACE unit during August and September of 2013. Charts were evaluated for house staff documentation regarding code status and goals of care. We reviewed all history and physicals, progress notes, and discharge summaries and searched for the following literature-based framework of goals:4 (1) be cured, (2) live longer, (3) improve or maintain function/quality of life, (4) be comfortable, (5) achieve life goals, (6) provide support for family/caregiver, and (7) other.
1. Toraya C: Evaluation of advance directives video education for patients. J Palliat Med 2014;17:942–946. 2. Levi BH, Wilkes M, Der-Martirosian C, et al.: An interactive exercise in advance care planning for medical students. J Palliat Med 2013;16:1523–1527. 3. Emanuel LL, Hauser JM, Bailey FA, et al.: Module 7: Goals of care, in the education in palliative and end-of-life care (EPEC) curriculum. Chicago, IL: EPEC, 2011. 4. Kaldjian LC, Curtis AE, Shinkunas L, Cannon KT: Goals of care toward the end of life: A structured literature review. Am J Hosp Palliat Care 2009;25:501–511.
Results
Of 77 patients included, mean age was 81.4. Results indicated that 97.4% (75/77) patients had their code status documented, while only 15.6% (12/77) had goals of care documented. Goals of care documentation were present only when patients elected comfort care or hospice. We were not able to identify documentation of other possible goals for health care.
Address correspondence to: Yuya Hagiwara, MD University of Texas Health Science Center at San Antonio Division of Geriatrics, Gerontology and Palliative Medicine 7703 Floyd Curl Drive MSC 7875 San Antonio, TX 78229
Discussion
Results suggest that although the rate of code status documentation was high, there was limited documentation by
E-mail: [email protected]
1 Division of Geriatrics, Gerontology and Palliative Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas. 2 Geriatric Research Education Clinical Center, South Texas Veterans Health Care System, San Antonio, Texas.
99
Copyright of Journal of Palliative Medicine is the property of Mary Ann Liebert, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
