While patient-centered care has been widely recognized as integral to high-quality care for over a quarter of a century, hospitals and health systems are missing the mark when goal concordant care (GCC) is compartmentalized as important only when a cure is no longer possible.
A recent study published in Cancer uncovered significant misalignment between treatment and patients’ goals for care. Compared with patients with other serious illnesses, a large portion of patients with late-stage cancer reported that their treatment was discordant with their own goals. The patients reported that their care focused on longevity when their preference was to prioritize comfort.
Though implementation challenges exist, organizations are faced with a vital opportunity to do better by elevating goal concordant care throughout the care trajectory as an essential aspect of providing patient-centered care. In an ever-evolving healthcare landscape, it is important for healthcare leaders to understand why GCC should become ingrained in every patient’s care as well as the most effective strategies they, as leaders driving change, can take to implement the approach.
At UT MD Anderson, we define GCC as an ongoing commitment to understanding what matters most to patients. This spans values, goals and preferences related to treatment intensity, outcomes and longevity. Working within a framework referred to as “goals of care decision making,” care teams take a patient-centered approach to making medical decisions in the setting of serious illness or complex care. This approach ensures that treatment choices are guided by what matters most to each individual while being grounded in the medical context. GCC aims to work at the intersection of science and humanity, because that is what healthcare is essentially about — the human aspect of care.
There’s an important question we should ask ourselves as healthcare leaders, and for the entire healthcare sector to consider. Why is 40% of healthcare dollars in the U.S. spent on patients in the last 30 days of a patient’s life? Culturally, we’re driven as providers to overcome disease — to beat it with interventions that contribute to longevity. How many of those cases lack shared decision-making about the patient’s preferences for interventions vs. quality of life?
Shared decision-making is vital in patient-centered care. Recently, a patient shared his experience with our team that is a true example of goal concordant care. When he was diagnosed with cancer, he engaged with his care team and told them that keeping the function of his hands was extremely important to him. Not losing the feeling in his fingers was crucial because he earns income by using a computer, and playing piano was a source of joy. The clinical team took the patient’s wishes into account and amended the care plan. The new plan was still effective but preserved his usage of his hands.
When we think about how we’ve centered patients in their plans of care, conversations informing GCC are inextricable in the process. Care team leaders should ask themselves: have we built in GCC conversations early in the patient’s care? Have we failed them by not having these conversations or not having them early enough?
Death isn’t a medical failure. Not talking about it is. Not creating the space for shared decision making is the failure. Being immersed in this work, we believe it is that powerful and consequential.
There remain challenges and barriers to elevating GCC as an essential aspect of patient-centered care. Many hospitals and health systems have their GCC efforts embedded within palliative care. However, GCC should form an integral part of the patient’s whole trajectory — pre-diagnosis, diagnosis, remission, relapse, survivor and end of life — and should be the responsibility of the whole care team, not palliative care clinicians only. Other challenges include not having frameworks, roadmaps or support for documenting goals in place to foster alignment between patients, their families and their care team.
It is important to note that our understanding of having conversations about goals of care must change. In the past, patients may have thought, “This conversation means that I’m dying.” On the other hand, clinicians are not trained in medical schools to have difficult conversations.
At UT MD Anderson, we have worked with care teams to implement training to debunk the idea that GCC conversations mean patients are dying. The goal is to normalize these conversations for every member of the care team — from clinicians to nurses to social workers. From our experience establishing the Center for Goal Concordant Care Clinical Operations, we’ve found the following to be key in implementing GCC across the institution:
- Aligning with leaders on how an institution will define and measure goal concordant care
- Equipping clinical staff with essential frameworks to complete goal concordant care conversations and document in medical records
- In parallel, equipping patients and families with a framework to be able to support goal concordant care for their loved one — including having goal concordant care conversations within 48 hours of a patient’s admission
If hospitals and health systems claim to deliver patient-centered care, they must support successful implementation of goal concordant care. This means providing their teams, patients and loved ones with the tools needed to support shared decision-making and integrating these efforts early on and throughout a patient’s care.
Nico Nortjé, PhD, is associate vice president of clinical ethics and goal‑concordant care at The University of Texas MD Anderson Cancer Center in Houston.
The post Patient-centered care cannot exist without robust support for goal concordant care appeared first on Becker's Hospital Review | Healthcare News & Analysis.
Source: Read Original Article
