ArticleJournal of general internal medicine2024
Classification of Documented Goals of Care Among Hospitalized Patients with High Mortality Risk: a Mixed-Methods Feasibility Study.
Article in Journal of general internal medicine, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Instability in End-of-Life Goals and Preferences of Patients Who Are Seriously Ill: A Systematic Review.JAMA network open · 2025Pooled it
- Large Language Models (LLMs) vs Manual Chart Review for Assessing Goal-Concordant Care: An Exploratory Study.The American journal of hospice & palliative care · 2026Article
- Factors associated with dying in hospital awaiting palliative care admission: a retrospective cohort study.BMC palliative care · 2026Article
- Content and Comprehensiveness of Goals-of-Care Documentation in Pediatric Patients.Journal of pain and symptom management · 2025Article
- Measuring Goal-Concordant Care Using Electronic Clinical Notes.JAMA network open · 2025Article
- Article
- Promoting early goals of care conversations in the CICU with a surprise question-based EHR workflow.BMC palliative care · 2024Observational
- Leveraging the electronic health record to identify delivery of goal-concordant care.medRxiv : the preprint server for health sciences · 2024Article
Corrections and comments
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Authors and funding
12 authors.
Funding
Abstract
backgroundThe ability to classify patients' goals of care (GOC) from clinical documentation would facilitate serious illness communication quality improvement efforts and pragmatic measurement of goal-concordant care. Feasibility of this approach remains unknown.
objectiveTo evaluate the feasibility of classifying patients' GOC from clinical documentation in the electronic health record (EHR), describe the frequency and patterns of changes in patients' goals over time, and identify barriers to reliable goal classification.
designRetrospective, mixed-methods chart review study.
participantsAdults with high (50-74%) and very high (≥ 75%) 6-month mortality risk admitted to three urban hospitals. MAIN MEASURES: Two physician coders independently reviewed EHR notes from 6 months before through 6 months after admission to identify documented GOC discussions and classify GOC. GOC were classified into one of four prespecified categories: (1) comfort-focused, (2) maintain or improve function, (3) life extension, or (4) unclear. Coder interrater reliability was assessed using kappa statistics. Barriers to classifying GOC were assessed using qualitative content analysis. KEY
resultsAmong 85 of 109 (78%) patients, 338 GOC discussions were documented. Inter-rater reliability was substantial (75% interrater agreement; Cohen's kappa = 0.67; 95% CI, 0.60-0.73). Patients' initial documented goal was most frequently "life extension" (N = 37, 44%), followed by "maintain or improve function" (N = 28, 33%), "unclear" (N = 17, 20%), and "comfort-focused" (N = 3, 4%). Among the 66 patients whose goals' classification changed over time, most changed to "comfort-focused" goals (N = 49, 74%). Primary reasons for unclear goals were the observation of concurrently held or conditional goals, patient and family uncertainty, and limited documentation.
conclusionsClinical notes in the EHR can be used to reliably classify patients' GOC into discrete, clinically germane categories. This work motivates future research to use natural language models to promote scalability of the approach in clinical care and serious illness research.
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