Using Design Thinking to Promote Goals of Care Conversations With Seriously Ill Patients

Abstract

Background: Goals of care (GOC) conversations can improve serious illness outcomes such as pain and symptom management and patient satisfaction.

Problem: However, we recognized that very few Duke Health patients who died had a GOC conversation documented in the designated electronic health record (EHR) tab. Therefore, in 2020, we set a target that all Duke Health patients who died should have had a GOC conversation documented in a designated EHR tab in the last 6 months of life.

Intervention: In developing a strategy to promote GOC conversations, we used two interwoven approaches. The first was RE-AIM, a model for designing, reporting and evaluating health behavior research. The second was less of a model than a way of approaching problems, known as "design thinking."

Outcomes: We employed both of these approaches in a system-wide effort that achieved a 50% prevalence of GOC conversations in the last 6 months of life.

Key message: In combination, simple interventions can have a significant impact on behavior change in an academic health system.

Lessons learned: We found that design thinking techniques offered a useful bridge between RE-AIM strategy and clinical.

Keywords: Communication; decision-making; ethicstactics; goals of care.