Goal-concordant care in the ICU: a conceptual framework for future research

Excerpt

The term “goal-concordant care” is increasingly used to describe the objective of interventions aimed at improving clinician–patient communication [1]. The US National Academy of Medicine calls for clinicians to work “with patients and families to ensure that care provided matches closely with each individual’s goals” [2]. The German Interdisciplinary Association for Intensive Care and Emergency Care recognizes that patients may reject proposed therapeutic goals if they do not align with patient preferences [3]. Moreover, the first recommendation of the critical care “Choosing Wisely Canada” campaign is to avoid life-supporting interventions “unless they are consistent with the patient’s values and realistic goals of care” [4]. Despite increasing interest across medical specialties, no methodology has been validated for measuring goal concordance [5]. Hence, we present a conceptual framework for understanding goal concordance in the adult ICU setting, describe challenges to measuring the incidence of goal-discordant care, and discuss implications for clinical research. …