Pilot study to improve goals of care conversations among hospitalists

Abstract Background Many hospitalized patients receive care that is not concordant with their goals. Teaching communication skills that better align goals and treatment can improve the care that patients receive. Objective To develop and test an innovative approach that encourages hospitalists to engage in goals of care conversations with their patients. Methods We recruited 14 hospitalists and randomized half to receive electronic health record alerts for patients who might benefit most from a goals of care conversation, as well as communication coaching. The coaching required an initial meeting, then audio recording of two goals of care conversations and feedback from the coach. Outcomes were the presence of goals of care conversations (primary), the quality of the goals of care conversations, physician perceptions of the intervention, and hospital metrics (e.g., 30-day readmissions, referrals to palliative care). Results We did not increase the frequency of goals of care conversations but did improve the quality of the conversations. Patients of physicians who received the intervention had fewer 30-day readmission rates and were less likely to die 90 days after admission than patients of physicians in the control arm. Patients of intervention physicians also had fewer palliative care consults than patients of control physicians. Conclusions Teaching hospitalists to have goals of care conversations translated into better skills and outcomes for patients. This pilot shows promise and should be tested in a larger trial.