title: Eliciting goals of care in a nursing home.
abstract: OBJECTIVE
  To identify enablers and barriers facing providers and staff in initiating Goals of Care (GOC) discussions with patients in the nursing home.
  
  
  METHODS
  Qualitative methods, one-on-one interviews. The interviews began with eliciting the participant's definition of GOC. The open-ended questions were designed to assess recent experience and satisfaction with the participant's role in the GOC discussion.
  
  
  METHODS
  Nursing home.
  
  
  METHODS
  We interviewed 23 nursing home staff and providers.
  
  
  METHODS
  Transcripts were qualitatively analyzed.
  
  
  RESULTS
  Five themes emerged that were identified as barriers to discussing GOC: (1) Fear of legal ramifications; (2) Not enough education on how to have a GOC discussion; (3) Family not involved on a regular basis; (4) Time pressure; (5) Interdisciplinary team not involved. Five themes also emerged that were identified as enablers to the GOC discussion: (1) Education/experience with the GOC discussion; (2) Interdisciplinary team involved in the discussion; (3) Established trusting relationship with the patient/family/other staff; (4) Terminal diagnosis/hospice involvement; (5) Discussion occurs in-person.
  
  
  CONCLUSIONS
  A major finding of these interviews is the lack of systematic attention to GOC in the nursing home setting. Since education and experience were identified as crucial to understanding GOC, more formal education and observed practice discussing GOC is needed for all staff. The outcomes of GOC discussions should be documented in the patient record and be accessible to all staff and communicated systematically to all staff. Addressing these barriers and facilitating these enablers to the GOC discussion will improve the care of nursing home patients.
authors.affiliation: Department of Family and Geriatric Medicine, University of Louisville, Louisville, KY 40202, USA. cdfurm02@louisville.edu
authors.forename: Christian Davis
authors.initials: CD
authors.lastname: Furman
authors.forename: Susan E
authors.initials: SE
authors.lastname: Kelly
authors.forename: Keith
authors.initials: K
authors.lastname: Knapp
authors.forename: Robyn L
authors.initials: RL
authors.lastname: Mowery
authors.forename: Toni
authors.initials: T
authors.lastname: Miles
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D004496:Education, Continuing; D005260:Female; D006040:Goals; D007722:Health Knowledge, Attitudes, Practice; D006707:Homes for the Aged / Q000458:organization & administration*; D006801:Humans; D007400:Interprofessional Relations; D007407:Interviews as Topic; D007629:Kentucky; D016365:Liability, Legal; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D009735:Nursing Homes / Q000458:organization & administration*; D010347:Patient Care Planning / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration; D011368:Professional-Family Relations; D036301:Qualitative Research