Goal-concordant care – searching for the holy grail

The notion that the care delivered to seriously ill patients ought to promote those patients’ goals — regarding such matters as aggressiveness of treatment, hoped-for functional outcomes, and ability to participate in future events — is widely supported by patients, caregivers, clinicians, health systems, and payers. The delivery of goal-concordant care has been identified as a key priority by the National Academy of Medicine,¹ proposed as a quality measure,² and rated by an expert panel as the most important outcome measure for studies of advance care planning interventions.³ Yet there are no methods that can reliably and accurately be used to measure whether care that was provided to patients was concordant with their goals.^2,3

Some investigators have argued that goal concordance may be inferred from measures of high-quality communication.⁴ Others have devised methods for determining whether specific decisions made in the intensive care unit were goal-concordant.⁵ But the lack of a generalizable method for assessing whether a patient’s overall treatment was concordant with the person’s goals greatly limits clinicians’ ability to know whether they are providing patient-centered care. It also hinders investigators’ ability to improve palliative care delivery, communication about serious illness, and other aspects of end-of-life care by means of randomized clinical trials.