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


This integrative review found evidence that GOC communication interventions were generally associated with improving GOC communication between seriously ill patients and their clinicians and families. The studies demonstrated 6 communication modes of GOC comprehension, communication, and collaboration for increasing patient-centered, goal-concordant EOL care. Goals-of-care communication interventions have some efficacy in improving communication about patient goals, EOL care preferences, and perceptions of both quality and satisfaction with of EOL care. If GOC communication interventions are to be effective in improving clinical outcomes and patient experience, they will need to be incorporated as system-wide tools for the broader population of seriously ill adults, much as health care directives and medical orders for life-sustaining treatment (Physician Orders for Life-Sustaining Treatment/Medical Orders for Life-Sustaining Treatment) have been adopted as standards of clinical practice. Standardizing GOC communication interventions can increase patient and family comprehension and improve communication and collaboration between patients, clinicians, and families. This integrative review's proposed conceptual model, shown in Figure 2, reveals that each of the 6 modes has a role to play in supporting the GOC communication process. Patient decision aids, especially electronic education tools, hold promise for efficiently increasing patient and family comprehension. Clinician communication training and standardized patient-clinician GOC discussion protocols are instrumental in improving communication. Supporting patient and family GOC communication, as well as early introduction of palliative care into a patient's care plan, could promote collaboration. Because of the trusted nature of their relationship with patients and families, nurses can play a key role in initiating and maintaining the ongoing GOC discussion. Critical to this process is recognizing nurses' duty to provide information and facilitation that will support a patient's and family's decision-making process.[55] Through open communication and collaboration, patient and family choices will be made known and honored and will be goal-concordant at the end of life.