The Association of Goals of Care Note Content With Patient Care Plan Decisions

CONTEXT: Documented goals of care conversations (GOCC) are associated with positive outcomes. Little is known about how specific content documented within GOCC notes may be associated with patient care plan decisions. OBJECTIVES: To assess the content of documented GOCC notes and identify how this content is associated with care plan decisions following the GOCC. METHODS: This cross-sectional, multihospital study assessed GOCC notes documented for seriously ill hospitalized patients between 2021 through 2023. We quantitatively assessed completion of check boxes in a standardized GOCC note template to identify content within GOCC notes. We used multivariable logistic regression to assess how content within GOCC notes was associated with patient care plan decisions. RESULTS: Five thousand four hundred seventy five patients across twenty-one hospitals had a documented GOCC during the study period. These patients had median age 76, were 48% female, and were 11% Black, 2% Other and 87% White. About half (55%) of GOCC notes documented a surrogate decision-maker. Two-thirds documented patient prognosis (66%) or patient values (68%). Documentation of patient prognosis or patient values was associated with a change in code status (aOR 2.2 95% CI 1.9-2.5; aOR 2.2, 95% CI 1.9-2.5), transition to comfort measures only status (aOR 2.8, 95% CI 2.4-3.4; aOR 2.0, 95% CI 1.6-2.4), and discharge with hospice (aOR 1.9, 95% CI 1.6-2.2; aOR 1.4, 95% CI 1.2-1.6). CONCLUSIONS: This multicenter study identified that documentation of patient prognosis or patient values in GOCC notes was often associated with comfort focused care decisions. Future research should explore the reasons for these findings.