• Moira O'Connor, Kaaren J Watts, Warren D Kilburn, Kitty Vivekananda, Claire E Johnson, Sharon Keesing, Georgia K B Halkett, Josephine Shaw, Valerie Colgan, Kevin Yuen, Renate Jolly, Simon C Towler, Anupam Chauhan, Margherita Nicoletti, and Anton D Leonard.
• WA Cancer Prevention Research Unit, School of Psychology, Faculty of Health Sciences, Curtin University, Perth, WA, Australia. m.oconnor@curtin.edu.au.
• J Gen Intern Med. 2020 Dec 1; 35 (12): 357235803572-3580.

BackgroundGoals of care (GOC) is a communication and decision-making process that occurs between a clinician and a patient (or surrogate decision-maker) during an episode of care to facilitate a plan of care that is consistent with the patient's preferences and values. Little is known about patients' experiences of these discussions.ObjectiveThis study explored patients' perspectives of the GOC discussion in the hospital setting.DesignAn explorative qualitative design was used within a social constructionist framework.ParticipantsAdult patients were recruited from six Australian hospitals across two states. Eligible patients had had a GOC discussion and they were identified by the senior nurse or their doctor for informed consent and interview.ApproachSemi-structured individual or dyadic interviews (with the carer/family member present) were conducted at the bedside or at the patient's home (for recently discharged patients). Interviews were audio-recorded and transcribed verbatim. Data were analysed for themes.Key ResultsThirty-eight patient interviews were completed. The key themes identified were (1) values and expectations, and (2) communication (sub-themes: (i) facilitators of the conversation, (ii) barriers to the conversation, and (iii) influence of the environment). Most patients viewed the conversation as necessary and valued having their preferences heard. Effective communication strategies and a safe, private setting were facilitators of the GOC discussion. Deficits in any of these key elements functioned as a barrier to the process.ConclusionsEffective communication, and patients' values and expectations set the stage for goals of care discussions; however, the environment plays a significant role. Communication skills training and education designed to equip clinicians to negotiate GOC interactions effectively are essential. These interventions must also be accompanied by systemic changes including building a culture supportive of GOC, clear policies and guidelines, and champions who facilitate uptake of GOC discussions.

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