Patient Self-Defined Goals: Essentials of Person-Centered Care for Serious Illness.
Sandra Ellen Schellinger, Eric Worden Anderson, Monica Schmitz Frazer and 1 others
PMID 28330379WHAT IT FOUND
Patients living with serious illness named nonmedical goals as often as medical goals.
Ask what matters, then record physical, social, family, financial, spiritual, and end-of-life wishes so care plans reflect the whole person.
Key findings
01Medical and nonmedical goals each made up 40% of the recorded goal statements.
02Nonmedical goals covered social, ethical, family, financial, psychological, housing, legacy, end-of-life, and spiritual domains.
03Patient goals were entered into an electronic health record flow sheet and automatically populated into care visit notes.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a descriptive analysis of recorded goals, not a trial, so it does not show that asking about goals improves care or quality of life. The sample came from one Midwestern health-care system and 88% were white, so the goals may not represent other communities. 68% of participants had heart failure, so the mix of goals may not apply to people whose main illness is cancer or dementia. Goals were collected by lay care guides during monthly visits, not necessarily by nurses, physical therapists, occupational therapists, or speech-language pathologists, so the workflow may not transfer directly. Some goals were repeated over time with little wording change. It was hard to tell when a goal shifted to a new focus.
The easy way to misread this
Do not read this as evidence that asking about whole-person goals improves care. The study described goals recorded in one palliative care program and did not test the approach against usual care.