Background

Patients who are facing a serious illness must make numerous complex healthcare decisions that will determine what treatment they receive, what their quality of life will be and how long they will survive. Too often, patients and their families must make these decisions without adequate communication about their hopes, fears, values and goals. The result is that many patients receive more treatment than they’d like, or treatment that is intended to prolong survival when their goals are actually to maximize comfort and preserve their quality of life.

Patients who don’t have access to open, accurate and empathetic communication about their goals can receive treatment that is overly aggressive and costly, which creates financial burdens for them and for their families. Poor communication also leads to increased side effects of treatment that could have been avoided, and worse quality of life due to additional time undergoing unnecessary tests and treatment. 

Overtreatment near the end of life has become one of the key issues facing U.S. healthcare policy today. There is an ongoing need for interdisciplinary efforts to provide care that is concordant with patients’ goals.

Project Description

Goalconcordant.care is a collaboration between Duke Health (including the School of Medicine and the School of Nursing) and Duke University. The aim is to implement a roadmap for goals of care conversations for patients with serious illness at Duke Health. Led by Duke Palliative Care and supported by the health system and its academic partners, goalconcordant.care is Duke Health’s strategy for ensuring that all patients have access to open, accurate and empathetic communication about their goals for care. 

When this effort began, only 2% of Duke Health patients who died had a goals of care conversation; now, almost half of Duke Health patients have documented goals of care conversations in the last six months of life. Building on the work of previous teams, this project team will continue this effort and investigate patient-provider communication in two complementary ways via a “hub and spoke” model.

• Mentored projects (“spokes”): First, each team member will be assigned to a mentor on the goalconcordant.care team. They will work on projects within the mentor’s field of research, selected for their fit with goalconcordant.care’s overarching aim of improving communication in serious illness.
• Central activities (“hub”): In addition to individual mentored projects, team members will participate in a series of works-in-progress groups and seminars. These sessions will be arranged throughout the year, occurring 2-4 times per month, and will be designed to allow students to share the results of their projects with other students and faculty. These sessions will also introduce students to palliative care clinicians so that they can learn about how these providers came to practice in this field. Students will also meet individually every month with the goalconcordant.care project manager to discuss educational and professional goals.

Anticipated Outputs

Policy-relevant results suitable for publication or inclusion in a grant proposal; presentations to Duke Health leadership; presentations at national meetings

Student Opportunities

Ideally, this project team will include 4 graduate students and 8 undergraduate students interested in the social sciences, data science, computer science, humanities, health and medicine, ethics and theology. Additionally, in line with efforts made by Duke Palliative Care to ensure racial and ethnic diversity within its programs, goalconcordant.care will aspire to create a collaborative community that mirrors the health system and its patient population. 

Learners who participate in this project will have the chance to become familiar with healthcare approaches to improving patient-centered care, engage with clinical stakeholders (such as providers, patients and family), contribute to publications and presentations, participate in data management/analysis, learn how to communicate within a multidisciplinary team and benefit from professional development and feedback.

A graduate student will be selected to serve as project manager.

Timing

Fall 2024 – Summer 2025

• Fall 2024: Onboarding; begin work with research mentors; modify Institutional Review Board (IRB) protocols; begin training; begin data collection and/or coding of existing data
• Spring 2025: Continue data collection; begin initial analysis; pilot and evaluate potential solutions; engage with clinical stakeholders; present to Duke Health leadership
• Summer 2025 (optional): Continue work with research mentors

Crediting

Academic credit available for fall and spring semesters; summer funding available

This Team in the News

Meet the Winners of the 2024 Bass Connections Student Research Awards
 

See earlier related team, Developing a Roadmap for Goals of Care Conversations at Duke Health (2023-2024).

Image: Goals of care, by Department of Medicine, Duke University School of Medicine