Use and Meaning of "Goals of Care" in the Healthcare Literature: a Systematic Review and Qualitative Discourse Analysis.

Autor: Secunda K; Northwestern University Feinberg School of Medicine, 633 N. St. Clair Street, 20th Floor, Chicago, IL, 60611, USA.; Department of Medicine, Division of Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, USA., Wirpsa MJ; Northwestern Memorial Hospital, Chicago, IL, USA., Neely KJ; Northwestern University Feinberg School of Medicine, 633 N. St. Clair Street, 20th Floor, Chicago, IL, 60611, USA.; Department of Medicine, Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA., Szmuilowicz E; Northwestern University Feinberg School of Medicine, 633 N. St. Clair Street, 20th Floor, Chicago, IL, 60611, USA.; Department of Medicine, Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA., Wood GJ; Northwestern University Feinberg School of Medicine, 633 N. St. Clair Street, 20th Floor, Chicago, IL, 60611, USA.; Department of Medicine, Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA., Panozzo E; Northwestern Memorial Hospital, Chicago, IL, USA., McGrath J; Northwestern Memorial Hospital, Chicago, IL, USA., Levenson A; Northwestern University Feinberg School of Medicine, 633 N. St. Clair Street, 20th Floor, Chicago, IL, 60611, USA.; Department of Medicine, Division of Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, USA., Peterson J; Northwestern University Feinberg School of Medicine, 633 N. St. Clair Street, 20th Floor, Chicago, IL, 60611, USA.; Galter Health Sciences Library and Learning Center, Northwestern University Feinberg School of Medicine, Chicago, USA., Gordon EJ; Northwestern University Feinberg School of Medicine, 633 N. St. Clair Street, 20th Floor, Chicago, IL, 60611, USA.; Department of Surgery, Division of Transplantation, Northwestern University Feinberg School of Medicine, Chicago, USA.; Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, USA.; Center for Bioethics and Medical Humanities, Northwestern University Feinberg School of Medicine, Chicago, USA., Kruser JM; Northwestern University Feinberg School of Medicine, 633 N. St. Clair Street, 20th Floor, Chicago, IL, 60611, USA. jacqueline.kruser@northwestern.edu.; Department of Medicine, Division of Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, USA. jacqueline.kruser@northwestern.edu.; Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, USA. jacqueline.kruser@northwestern.edu.
Jazyk: angličtina
Zdroj: Journal of general internal medicine [J Gen Intern Med] 2020 May; Vol. 35 (5), pp. 1559-1566. Date of Electronic Publication: 2019 Oct 21.
DOI: 10.1007/s11606-019-05446-0
Abstrakt: Background: The specific phrase "goals of care" (GOC) is pervasive in the discourse about serious illness care. Yet, the meaning of this phrase is ambiguous. We sought to characterize the use and meaning of the phrase GOC within the healthcare literature to improve communication among patients, families, clinicians, and researchers.
Methods: A systematic review of the English language healthcare literature indexed in MEDLINE/PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus was performed in October of 2018. We searched for all publications with the exact phrase "goals of care" within the title or abstract; no limitations on publication date or format were applied; conference abstracts were excluded. We used qualitative, discourse analysis to identify key themes and generate an operational definition and conceptual model of GOC.
Results: A total of 214 texts were included in the final analysis. Use of GOC increased over time with 87% of included texts published in the last decade (2009-2018). An operational definition emerged from consensus within the published literature: the overarching aims of medical care for a patient that are informed by patients' underlying values and priorities, established within the existing clinical context, and used to guide decisions about the use of or limitation(s) on specific medical interventions. Application of the GOC concept was described as important to the care of patients with serious illness, in order to (1) promote patient autonomy and patient-centered care, (2) avoid unwanted care and identify valued care, and (3) provide psychological and emotional support for patients and their families.
Discussion: The use of the phrase "goals of care" within the healthcare literature is increasingly common. We identified a consensus, operational definition that can facilitate communication about serious illness among patients, families, and clinicians and provide a framework for researchers developing interventions to improve goal-concordant care.
Databáze: MEDLINE
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