Goals of care: a concept clarification

Abstract

Aim: To report an analysis and clarification of the concept of goals of care.

Background: Goals of care have been used by healthcare providers since 1978, but no operationalized, consensual definition exists.

Design: Norris's method of concept clarification was used to create an operational definition, conceptual model and testable hypotheses of goals of care from the healthcare provider's perspective.

Data sources: Data came from current research reports, interviews with experts and web sites of professional organizations. Research reports were published between 2003-2013.

Methods: Antecedents, definitions and consequences were systematized and organized into coherent and more abstract groups to define goals of care. A conceptual model and testable hypotheses were created from this process.

Results: Goals of care are desired health expectations that are formulated through the thoughtful interaction between a human being seeking medical care and the healthcare team in the healthcare system and are appropriate, agreed on, documented and communicated.

Conclusions: Development of clear goals of care can increase patient satisfaction and quality of care while decreasing costs, hospital length of stay and hospital readmission. Goals of care are dynamic and should be reassessed regularly. How and when goals of care transition from implicit to explicit should be explored further, and what prompts this transition. Nurses, physicians and healthcare providers need education on how to best fill their roles in the development of goals of care.

Keywords: communication; concept analysis; concept clarification; goals of care; nursing; palliative care; patient satisfaction.