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Goal-concordant care – searching for the holy grail

The New England Journal of Medicine October 24, 2019

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Research Areas

PAIR Center Research Team


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.