During acute care episodes, patients aren’t often engaged to elicit their healthcare goals. This can result in sub-optimal transitions home from the hospital due to unmet patient needs. Engaging your patients – especially older adults – around what matters most in their goals of care is a crucial step in coming up with a successful care plan. It might be most useful to elicit healthcare goals in the following three situations:
- when a patient has a serious illness (i.e. resuscitation decisions)
- making decisions about disposition (admit, discharged, care transitons)
- when a patient has a chief complaint/presentation for a concern that for NOT result in a fairly standard, protocolized approach to their care (e.g. chest pain).
Questions designed to elicit goals
Patients don’t necessarily think about their care in terms of “goals” but rather worries, concerns, and/or expectations of what will happen from the visit. As such, we can use alternative language to create a more patient-centered approach. It can also be helpful to elicit information about caregiving context and functional status in order to make the healthcare goal/expectation more actionable for clinicians.
Below is a series of questions that can be adapted for your hospital team as an interview guide for eliciting patient goals of care. You can download a PDF copy here.
These questions were tested with emergency department patients and are phrased for clarity. The questions are intended to be used by clinicians, social workers, volunteers, or other ancillary personnel.
Interviewers Guide
PRIMARY CONCERN
When you came into the ED today, what was your biggest worry about your health?
GOAL OF ED VISIT
What are you most hoping will happen from this ED visit? (Figuring out what’s going on/diagnosis, controlling symptoms, getting back to routine, getting reassurance, coordinating care, completing a referral?)
CAREGIVING SUPPORT
While you recover, you might need help with day-to-day activities. Are there people who live with you? Are there people who could come to help you with this? (With things like medications, helping you around your home, monitoring and making sure you’re feeling okay, or just checking in on you?)
- [ ] Lives alone
- [ ] Lives with others: (roommates vs. family members) _______________
Specific things that family, friends, home health, community could help with: __________
(check-in/monitoring for worsening symptoms, meal preparation, medication pick-up, getting to bathroom to toilet/bathe, transferring from chair/bed, transportation to a medical appointment).
OUTPATIENT FOLLOW UP
Do you have a doctor you see regularly? [ ] Yes [ ] No
Type of doctor, if specified: __________
If yes, how easy or hard would it be to follow up with your doctor within the week?
Age-Friendly Assessment
PRIMARY CONCERN
When you came into the ED today, what was your biggest worry about your health?
GOAL OF ED VISIT
What are you most hoping will happen from this ED visit?
PREFERNECES ABOUT HOSPITAL ADMISSION
Let’s say that today, we find we can either treat you here in the hospital or at home with follow-up. What would you prefer? (Why?)
CAREGIVING SUPPORT
While you recover, you might need help with day-to-day activities. Are there people who live with you? Are there people who could come to help you with this? (With things like medications, helping you around your home, monitoring and making sure you’re feeling okay, or just checking in on you?)
- [ ] Lives alone
- [ ] Lives with others: (roommates vs. family members) _______________
Specific things that family, friends, home health, community could help with (note to interviewer, delete any categories that don’t apply):
- [ ] check-in/monitoring for worsening symptoms
- [ ] meal preparation
- [ ] medication pick-up
- [ ] getting to bathroom to toilet/bathe
- [ ] transferring from chair/bed
- [ ] transportation to a medical appointment vs. patient drives on their own
- [ ] other
OUTPATIENT FOLLOW UP
Do you have a doctor you see regularly? [ ] Yes [ ] No
Type of doctor, if specified: __________
If yes, how easy or hard would it be to follow up with your doctor within the week?