Goals of care (GOC) conversations are a necessary tool in gathering information about patients’ healthcare wishes.
In 2019, with the goal of increasing the quality and frequency of these important conversations, Duke Health began developing a new resource: Duke CARES – Conversations Anchored in Respect, Evidence, and Shared decision-making. This initiative partnered with clinicians around the health system, building on current practices and offering tools to document and report when these communications happen.
"These conversations are intended to elicit the values, preferences, and wishes of a patient so that all care is concordant with those patient wishes," says Kristen Lakis, Duke Palliative Care Strategic Services Associate.
Incorporating this effort into the workflow of a busy inpatient or outpatient setting can be tricky. The team began the process with pilot groups at the Duke Outpatient Clinic and the Duke Center for Brain & Spine Metastasis. These pilot groups help identify higher-risk populations to target for conversations, utilize Duke CARES resources for training, documentation, and reporting, and develop a workflow that builds on the strengths of the unit in order to have these conversations consistently in a sustainable way.
“Ultimately our goal would be for every patient in our health system to have a goals of care conversation, but we know for some patients it is crucial that these conversations happen sooner rather than later," says Lakis.
Educational Video Library
These conversations with patients can be challenging. To help teach the core skills of how to have these GOC conversations, the CARES team from Duke Palliative Care created a video library of experienced clinicians discussing tips on various topics.