• David Casarett, Kristen Lakis, Jessica E Ma, Jonathan Fischer, and Salam Ibrahim.
• Department of Medicine (D.C.), Duke University School of Medicine Duke Health, Durham, North Caroline, USA. Electronic address: casarett@gmail.com.
• J Pain Symptom Manage. 2023 Aug 1; 66 (2): e275e281e275-e281.

BackgroundGoals of care (GOC) conversations can improve serious illness outcomes such as pain and symptom management and patient satisfaction.ProblemHowever, we recognized that very few Duke Health patients who died had a GOC conversation documented in the designated electronic health record (EHR) tab. Therefore, in 2020, we set a target that all Duke Health patients who died should have had a GOC conversation documented in a designated EHR tab in the last 6 months of life.InterventionIn developing a strategy to promote GOC conversations, we used two interwoven approaches. The first was RE-AIM, a model for designing, reporting and evaluating health behavior research. The second was less of a model than a way of approaching problems, known as "design thinking."OutcomesWe employed both of these approaches in a system-wide effort that achieved a 50% prevalence of GOC conversations in the last 6 months of life.Key MessageIn combination, simple interventions can have a significant impact on behavior change in an academic health system.Lessons LearnedWe found that design thinking techniques offered a useful bridge between RE-AIM strategy and clinical.Copyright © 2023 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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