Topic: Barriers to Goals of Care Discussion and Advance Care Planning

Background: Goals of care (GOC) discussions are critical conversations between healthcare providers and patients that ensure medical treatments align with patients' values and preferences. Despite their importance in improving patient satisfaction and outcomes, numerous barriers hinder these discussions.

Introduction: The Goals of Care (GOC) discussions are structured conversations between healthcare providers and patients (or their families) aimed at understanding the patient’s preferences, values, and desired outcomes for their medical treatment and care. These discussions are crucial in establishing a clear, shared understanding of what the patient hopes to achieve with their healthcare, whether it involves curative treatments, palliative care, or a combination. Advance Care Planning (ACP) is a proactive process that allows individuals to make decisions about their future healthcare preferences in case they become unable to communicate those decisions. There are multiples barriers related to Patient, Family, and Physician which we need to know to have better GOC and advance care planning with our patients. The aim of this Study was to Identify the barriers towards to Goal of Care Discussion and Advance Care Planning in our Setting from the Perspective of Medical Residents and Attendings. Methodology: The methodology of this study employs a cross-sectional and qualitative approach. Data collection was conducted using Google Forms, which were distributed through Outlook Email and Microsoft Teams. The study was carried out at CCMC from January 2024 to May 2024. Participants included internal medicine residents from all three years, transitional year residents, and Crozer attendings. Data analysis was performed using SPSS v29.

Results: The results of the study revealed several key insights regarding the awareness and practices related to advance directives and goals of care (GOC) discussions among the participants. Only 40.6% of the study population were unaware of the advance directive tab in EMR. Only 7.8% of participants documented GOC and advance planning in the dedicated EMR tab for advance care planning, with the majority opting to include this information in HPI/progress notes instead. Challenges in having GOC discussions were reported, with 56.3% sometimes and 12.5% always experiencing difficulties. Only 23.4% of respondents consistently discussed GOC with patients aged 65 and older with comorbidities such as COPD, CHF, and dementia. Additionally, only 37.5% regularly reviewed charts to find prior documentation on advance directives and living wills. Discussion and Conclusion: The barriers to the goals of care discussions and advance care planning identified in this study were like those reported in surveys conducted at other hospitals and institutions. We can overcome some of barriers by having GOC early with our Patients and using a Standardized Template for Advance care Planning in EMR.