Setting Goals at the End of Life

If one purpose of palliative care is to prevent suffering, then communication about what matters most to the patient is critical. A new study is the first to empirically confirm that conversations about goals are taking place, as they should be.

Robert Gramling, M.D., D.Sc., a Department of Family Medicine researcher and attending physician on the URMC palliative care service, said that when doctors and patients talk about the patient’s personal goals—in the context of who they are and how their health is affecting them—it creates a better platform for shared decision-making.

Clinicians are often asked to help patients identify and prioritize what they want to achieve during their remaining lifetime, which guides decisions about treatment. However, this conversation is more challenging when suffering, fear, and confusion reign.

To study the process of goal expression in this setting, Gramling’s team directly observed and analyzed 71 audio-recorded palliative care conversations with hospitalized patients. The Journal of Pain and Symptom Management published the article.

Results showed that seven out of 10 conversations included at least one goal expression about length or quality of life, with a focus on social roles, relationships and the best location to live or die. Goal expressions are also strongly influenced by existential suffering or feelings of anxiety and loss of control, the study said.