Background: Documentation of goals of care (GOC) discussions is a critical aspect of caring for individuals with serious illness. In this study, we evaluated the use of a standardized GOC template across three Canadian health care sites, utilizing both quantitative and exploratory qualitative approaches to determine whether the template was associated with more comprehensive documentation. Methods: This was a multisite retrospective study. The frequency of documentation of each component of a GOC discussion was compared between notes that used the template and those that did not using chi-square (χ2) tests. The potential association between the characteristics of patients (age, sex, primary diagnosis) and the use of the template was determined using a multivariate binary logistic regression analysis. Semi-structured interviews and focus groups with key informants were conducted as part of an exploratory descriptive qualitative analysis. Results: The GOC template was used to document conversations 50% of the time, while in the remaining 50% of charts, the template was deleted and replaced with a narrative note. Compared to narrative notes, GOC conversations documented within the template were statistically more likely to provide comprehensive documentation. The odds of the GOC template being used were not associated with the age, sex, or primary diagnosis of the patient. The pilot qualitative analysis highlighted themes of utility and usability. Conclusion: Uptake of a standardized GOC template at our institution was strongly associated with more complete GOC documentation. Although the template went through a participatory design process, the current study reveals significant deficits in both utility and usability.
Chakraborty et al. (Thu,) studied this question.