title: The Goals of Patient Care project: implementing a proactive approach to patient-centred decision-making.
abstract: BACKGROUND
  Patients in the later stages of their lives risk being harmed by futile or unwanted interventions if realistic care goals and patient values are not recognised. Doctors have difficulty discussing and informing patients' healthcare goals.
  
  
  OBJECTIVE
  To review implementation of a Goals of Patient Care (GOPC) summary in medical inpatients and its applicability in emergency medical response (EMR) situations.
  
  
  METHODS
  Single-centre cross-sectional study of adult medical inpatients and adult inpatients requiring EMR at a Victorian general hospital.
  
  
  METHODS
  presence and content of GOPC summary, secondary review of decision-making and discussion documentation, patient characteristics; EMR precipitants and outcomes.
  
  
  RESULTS
  GOPC were documented for 82 of 101 patients. One had an existing advance directive, and six had records of a patient-appointed substitute decision-maker. For patients with GOPC, 80 had life-prolonging treatment aims, with a varying degree of treatment limitation in 48. Discussion with patient or substitute decision-maker was evident in 43 cases. GOPC were documented prior to nine of 23 EMR. The EMR triggered a GOPC modification in three instances.
  
  
  CONCLUSIONS
  Introduction of a routine GOPC summary encourages consideration of goals of care for most medical inpatients. Few have pre-existing records of their wishes, and there are opportunities for improvement in this regard. Doctors may still have difficulty determining goals of care, and discussion of GOPC with patients and families may not be clearly documented. Most patients requiring EMR do not have prior GOPC review, and the role of the summary in these situations remains unclear.
authors.affiliation: Department of Palliative and Supportive Care, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Brimblecombe
authors.forename: D
authors.initials: D
authors.lastname: Crosbie
authors.forename: W K
authors.initials: WK
authors.lastname: Lim
authors.forename: B
authors.initials: B
authors.lastname: Hayes
mesh_terms: D032722:Advance Care Planning / Q000331:legislation & jurisprudence / Q000458:organization & administration; D016223:Advance Directives / Q000331:legislation & jurisprudence; D000368:Aged; D001315:Australia; D003142:Communication; D003657:Decision Making; D006801:Humans; D010353:Patient Education as Topic; D057240:Patient Preference / Q000706:statistics & numerical data; D010817:Physician-Patient Relations; D019727:Proxy / Q000706:statistics & numerical data
keywords: advance care planning; communication; decision-making; futility; resuscitation orders