Prioritizing Patient Wishes with the Goal Concordant Care Lab (2025-2026)

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 would 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.

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. 

Project Description

This project team will investigate the features of high quality, patient-centered communication, exploring what good patient-provider communication looks like, where needs are the greatest, what the barriers are to communication in a busy clinical setting, and whether or not advances in communication improve health-related outcomes. In 2025-2026, the team will also expand their focus to include Artificial Intelligence (AI) and large language models to support Goals of Care conversations.

The project team will operate 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; research presentations; publications

Student Opportunities

Ideally, this project team will include 2 graduate students and 8 undergraduate students interested in the social sciences, data science, computer science, humanities, health and medicine, nursing, ethics and theology.

Team members will become familiar with health care 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 2025 – Spring 2026

• Fall 2025: Shadow faculty; seek Institutional Review Board (IRB) approval; conduct literature reviews; code/analyze data; contribute to dissemination products; present findings
• Spring 2026: Shadow faculty; seek IRB approval; conduct literature reviews; code/analyze data; contribute to dissemination products; present findings
• Summer 2026 (optional): Students may continue research with mentors if desired by both team members

Crediting

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

See related team Developing a Roadmap for Goals of Care Conversations at Duke (2024-2025).