title: Understanding Goals of Care Statements and Preferences among Patients and Their Surrogates in the Medical ICU.
abstract: BACKGROUND: Treatment decisions should be based on patients' goals of care to provide an ethical, patient-centered framework for decision-making.  OBJECTIVES: The purpose of this study is to improve our understanding about how patients' and surrogates' goals of care are communicated and interpreted in an MICU.  METHODS: One hundred patients admitted to an MICU, or their surrogates, responded to an open-ended question about goals of care for their hospitalization followed by a closed-ended question regarding their most important goal of care. Investigators interpreted participants' open-ended responses and compared these interpretations with participants' closed-ended, most-important-goal selections.  RESULTS: Investigators' interpretations of participants' open-ended goals of care responses matched participants' closed-ended most important goal of care in only 28 of 100 cases. However, there was good inter-rater reliability between investigators in their interpretation of participants' open-ended responses, with agreement in 78 of 100 cases.  CONCLUSIONS: Clinicians should be cautious in interpreting patients' or surrogates' responses to open-ended questions about goals of care. A shared understanding of goals of care may be facilitated by alternating open-ended and closed-ended questions to clarify patients' or surrogates' responses.
authors.affiliation: The University of Iowa College of Nursing and Institute for Clinical and Translational Science, The University of Iowa.
authors.forename: Debra S
authors.initials: DS
authors.lastname: Brandt
authors.forename: Laura A
authors.initials: LA
authors.lastname: Shinkunas
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Gehlbach
authors.forename: Lauris C
authors.initials: LC
authors.lastname: Kaldjian