1. Todd, Betsy MPH, RN


* Patient-specific guides were effective in promoting documented goals-of-care discussions and were feasible and acceptable to patients, surrogate decision makers, and clinicians.



Article Content

For patients with life-limiting illnesses, high-quality goals-of-care communication among clinicians, patients, and surrogate decision makers-and documentation of such discussions-can guide treatment decisions and improve quality of care. A recent randomized clinical trial evaluated the efficacy, feasibility, and acceptability of a patient- and clinician-facing communication-priming intervention (Jumpstart Guide) to prompt and guide goals-of-care discussions among hospitalized patients with serious illness.


Participants included adults with chronic life-limiting illness, frail adults ages 65 years or older, and inpatients ages 80 years and older, as well as their clinicians. Of 428 eligible patients or their surrogates, 150 consented to participate, with half randomized to the Jumpstart intervention and half serving as controls. Clinical notes from participants' records were reviewed for documentation of a goals-of-care discussion.


Documentation of goals-of-care discussions were found in the records of 21% of intervention group patients and 8% of control participants. Of the 68 patients and surrogates in the intervention who completed follow-up questionnaires, 27 (40%) remembered using the Jumpstart Guide to enhance their communication with clinicians. Among the completed questionnaires from clinicians, 61 of 72 (85%) indicated the clinician recalled receiving a Jumpstart Guide. Of these, 37 (61%) indicated the clinician had used it to facilitate a goals-of-care conversation with a patient.


The authors note that at the time of study enrollment, 47 of the 150 participants (31%) said they didn't want to discuss goals of care with their inpatient team-possibly, the authors suggest, because many patients have only short-term relationships with these clinicians, among other reasons. In addition, only 35% of eligible patients consented to participate, so this kind of intervention might only reach a minority of eligible patients. The authors suggest that a redesigned Jumpstart Guide, directed only to clinicians, may increase its scalability and dissemination.


Lee RY, et al JAMA Netw Open 2022;5(4):e225088.