Developing clinical standards for Goals of Care discussions
The problem
Goals of Care (GOC) discussions are recommended as part of every clinical encounter involving a decision, especially in cases of elderly care, chronic or life-threatening illness, or risky treatment. When GOC discussions don’t take place, it can lead to unwanted or low-value care. Physicians often bear sole responsibility for conducting these discussions, typically spending between 10 to 15 minutes per case; across Canada, this translates into hundreds of thousands of hours per year. Despite the critical nature of these discussions, there is no systematic or standardized practice.
The solution
ASKmeGOC is a web app that facilitates GOC discussions in patients at high risk of adverse outcomes through a shared team approach. This new clinical standard allows nurses, physician assistants and other allied health professionals to initiate and navigate GOC discussions in a safe, confident and systematic fashion. This app has been verified in an initial pilot study and is currently the focus of the largest randomized clinical trial ever conducted at a community hospital.
“Our ASKmeGOC tool can be used by any health care provider to deliver a best practice goals of care discussion in a systematic, efficient and validated manner in any patient at high risk of adverse outcomes. This grant will permit the implementation of the ASKmeGOC tool across many acute and primary healthcare systems, alleviating the clinical and administrative burden for physicians attributable to goals of care discussions.”
The innovators
ASKmeGOC was developed by a team of intensivists at the Royal Victoria Regional Health Centre (RVH), led by Dr. Giulio DiDiodato, RVH chief research scientist.
RHV is a 408-bed large acute care community hospital located in Barrie, Ont., providing specialty clinical services to more than 500,000 people.