Goal-Concordant Care: End-of-Life Planning Conversations for All Seriously Ill Patients

Substantial evidence indicates that goals-of-care (GOC) conversations in the setting of serious illness can improve a variety of health outcomes. However, only 3% of seriously ill Duke Health patients who died had goals of care documented in the electronic health record (EHR) space designated for these conversations. In 2020, Duke Health embarked on an initiative to increase the number of seriously ill patients with a documented GOC conversation in the last 6 months of life. This effort included the creation of templates for GOC conversations, education for clinicians, triggers in the EHR system to remind clinicians to have these conversations, and dashboards to track results. By May of 2022, half of Duke Health patients with serious illness who died had a documented GOC conversation in the last 6 months of life. Several clinical departments achieved higher rates of documentation (e.g., palliative care, 85%; hospital medicine, 56%). Progress was slower for other specialties, including cardiology (36%), oncologic surgery (45%), and neurology (29%).