Goals of care conversations: Palliative care practice change
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Jeannine M. Haberman, DNP, MSN, MBA, CNE - https://www.linkedin.com/in/jeanninehaberman/
- Sigma Affiliation
- Omega Gamma
- Contributor Affiliation(s)
- Loyola University Chicago, Chicago, Illinois, USA
Advance Directive (AD) documentation in the Electronic Healthcare Record (EHR) remains critical for palliative care (PC) patients to avoid unwanted treatments. Closer management of PC patients may close the AD completion gap through a new nursing practice change, Goals of Care (GOC) Conversations. These GOC conversations are private, in-person discussions the PC team has with PC patients to better understand and properly document the patients’ wishes in the EHR. These conversations are voluntary, explain ADs, and may evolve over time. The research supports that GOC conversations improve AD completion. This project evaluated the effectiveness of AD completion rates after GOC conversations for PC patients in this selected setting. The PICOT question “In an acute care setting, how does the implementation of organizational goals of care (GOC) conversation with palliative care patients affect the number of completed advanced directives upon admission over a 10 week period?” was framed with the Chronic Care Model theory. Methods included a retrospective evaluation of AD documentation and analysis of the relationship of AD completion after the GOC conversations. Of the 345 patients reviewed, 196 patients had previously completed ADs and 149 patients had not previously completed their ADs. The data indicated that 94 PC patients, or 63%, experienced a change in code status from blank to complete after the GOC conversation practice change, reflecting a 73% increase. Limitations included a convenience sampling. The results support that nurses are well-positioned to educate PC patients regarding ADs, and show that GOC conversations improve PC patient’s completion of ADs.
Design-A causality research design was used in a Midwestern US acute care setting in fall of 2018, to determine if variation in the GOC conversation implementation leads to improved variations in the AD completion. Conclusion-The project measured what I wanted it to measure. The poor AD completion rate problem was addressed with GOC conversations. Initial results reflect a desirable outcome. Among PC patients, our preliminary findings strongly suggest GOC conversations proactively improve AD documentation in the EHR. GOC conversations and GOC training will continue at this facility. This study encourages additional studies on GOC in the palliative care population and beyond. Relevance to Clinical Practice- Nurses are an integral part of the healthcare team. The results support that nurses are well-positioned to educate PC patients regarding ADs. This project supports that GOC conversations improve PC patient’s completion of ADs. Significance of Capstone Project- Improved hospital outcomes, patient satisfaction, and nurse satisfaction. Future recommendations include extending the GOC conversations to other service lines in the hospital and perhaps extending GOC training to the ancillary departments. Based on the recent literature, chaplains, social workers, and case managers may be considered for GOC champion training in the future (Cassarett et al., 2016). Extending service lines to include cardiology, neurology, and pediatric oncology services. Extend the GOC conversations to OP settings and LTC facilities (Jeuland et al., 2017).
| Type | DNP Capstone Project |
| Acquisition | Self-submission |
| Review Type | None: Degree-based Submission |
| Format | Text-based Document |
| Evidence Level | Quality Improvement |
| Research Approach | Translational Research/Evidence-based Practice |
| Keywords | Goals of Care Conversations; Palliative Care; Palliative Care Nursing; Intervention Implementation; Organizational Change; Quality Improvement |
| Grantor | Capella University |
| Advisor | Harris, Colleen; Van Riel, Yvonne; Van Gilder, Jenna |
| Level | DNP |
| Year | 2019 |
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