Impact of an Early Goals of Care Discussion on Patient Satisfaction and Quality of Life among Seriously Ill Patients Admitted to the Medical Wards - A Quality Improvement Project.

Abstract

Objectives: The objective of this study was to achieve integration of goals of care discussion (GOCD) as a routine part of assessment among seriously ill patients admitted to medical wards and assess its impact on patient satisfaction, caregiver satisfaction and quality of life (QOL).

Materials and methods: This was non-randomised before and after study - A quality improvement project involving three plan-do-study-act (PDSA) cycles each of 6 weeks duration. The study included a total of 60 patients and their caregivers admitted to the Internal Medicine Unit in a tertiary care hospital in South India. Junior residents from Internal Medicine were trained in conducting a GOCD through a face to face training session and through an online training program using capc.org modules. Through a process of three PDSA cycles, we introduced the documentation of GOCD as a routine part of the assessment of seriously ill patients and assessed its impact on QOL and patient satisfaction.

Results: Following the introduction of GOCD, patient and caregiver satisfaction had a statistically significant improvement across the majority of the assessed domains, and there was an overall improvement in the mean World Health Organization QOL Brief Version QOL scores by 4.8.

Conclusion: Among patients with serious illness, GOCD improved patient and caregiver satisfaction and QOL. Such conversations are essential to align the care delivery with patient preferences and help in providing patient-centred care.