Communication Interventions to Improve Goal-Concordant Care of Seriously Ill Patients

An Integrative Review

Frank Bennett, MDiv, BS; Susan O'Conner-Von, PhD, RN-BC, CNE


Journal of Hospice and Palliative Nursing. 2020;22(1):40-48. 

In This Article


Eligibility and Inclusion Criteria

The review's inclusion criteria employed a PICOS (population, intervention, comparator, outcome, and study) design framework for eligibility. The population was defined as seriously ill patients and their family and health care clinicians; the interventions as education, tools, and decision aids to improve as GOC communication; the comparator as usual EOL care; the outcome as improved GOC communication and support for patient-centered, goal-concordant care; and study designs as RCT's published between 2009 and 2018 in English-language peer-reviewed journals. Excluded studies were those whose interventions did not include GOC communication and support, all research studies that were not RCTs, and those that did not have outcomes that demonstrated improvement in GOC communication and support.

Search Strategy

A preliminary search of the Ovid MEDLINE, Cochrane, and Mendeley Elsevier databases was conducted of studies published in English-language peer-reviewed journals using the following key words: serious illness, m.p.; goal* care, m.p., which yielded 6651 publications. These were further screened using the following key words: nurs*, m.p.; whole person care, m.p.; or goal concordant care, m.p. A preliminary search revealed 7 systematic reviews of GOC communication studies published between 1980 and 2015. Reviews have been performed to examine (1) evidence for a specific GOC communication intervention model,[10–12] (2) specific populations for GOC communication interventions,[6] (3) GOC communication intervention evidence for specific care settings,[1,13] and (4) evidence for shared decision-making GOC interventions.[14] None of the 7 compared the recent evidence from experimental studies of GOC interventions across multiple modes of communication.

Data Collection

The primary researcher conducted the data collection and quality assessment process, with the secondary researcher checking the data collection process using the PRISMA flowchart method shown in Figure 1.[15] Each study's full text was reviewed, and relevant data extracted using a worksheet developed by the primary researcher. Extracted data for each study included relevant study characteristics, such as study design, country of origin, sample size, characteristics and setting, study aim, intervention description, frequency and adherence, measurements, outcomes, results, and limitations.

Figure 1.

Randomized controlled trial studies of goals-of-care communication PRISMA flow diagram.