A Scoping Review on Goals of Care Discussions in Surgery: How Are We Doing and How Can We Do Better?

Abstract

Background: Discussing GOC is essential to ensuring that patients' treatment recommendations and care plans are aligned with their preferences, priorities, and values. This review aims to characterize the existing literature on the quality, practices, and frameworks of goals of care (GOC) discussions in surgery to identify gaps and propose strategies for improvement.

Methods: MEDLINE, MEDLINE In-Process/ePubs, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Web of Science, Scopus, and ClinicalTrials.Gov were searched using terms related to GOC, surgery, and best practices or education. The search strategy was run from inception to July 29, 2022. Studies regarding the quality of GOC discussions in surgery were included.

Results: The search identified 14,254 articles from which 37 were included for review. Key findings included (1) the reactive nature of GOC discussions and initiating conversations in response to acute health changes, (2) ambiguity around patient autonomy and the surgeon's duty to prioritize surgical treatment, (3) surgeons as curators of information, and (4) tendency of surgeons to provide a set of standard treatment pathways and determine specific care decisions rather than establish understanding of patients' long-term goals.

Conclusion: Further research is needed to determine best practices for caregiver and next-of-kin involvement and expand the diversity of reported experiences to include patients from diverse ethnic backgrounds and genders and individuals from rural and lower-resource communities. Findings from this review have important implications for improving GOC conversations to ensure they support patient-centered care.