Feasibility and Acceptability of Goals of Care Elicitation in an Emergency Department Setting (RP112)

Outcomes 1. Participants will be able to self-report the ability to describe and evaluate the feasibility of implementing a systematic goals-of-care survey in the emergency department among older patients with serious illness.2. Participants will be able to self-report the ability to adapt and implement a systematic approach to goals-of-care elicitation in their own emergency department practice setting to facilitate opportunities to improve goal-concordant care. Key Message Early elicitation of patients’ goals of care (GOC) is essential for providing goal-concordant care in serious illness. Among 40 older adults with serious illness who presented to the emergency department (ED), it was feasible and acceptable to systematically assess their overall GOC: longevity, function, or comfort-focused. Importance Emergency department (ED) visits offer a critical opportunity for early, systematic elicitation of GOC among patients with serious illness to facilitate goal-concordant care, but the feasibility and acceptability of this approach is unknown. Objective(s) To assess feasibility and acceptability of a brief GOC assessment in an ED setting. Scientific Methods Utilized We conducted a single group, prospective pilot study in an academic ED among patients ≥65 years of age from November 2022 to June 2023. Trained research associates (RAs) administered two multiple-choice questions to document patients’ overall GOC that were developed from a literature review and consultation with experts in palliative care, emergency medicine, and critical care. Survey comprehension and acceptability were evaluated using a teach-back technique and qualitative interviews with patients, and field notes from the RAs. Results A total of 40 participants were enrolled, and all completed the survey, adequately taught-back the GOC questions, and stated that they would be comfortable if asked the questions directly by ED providers. RAs reported the survey to be acceptable and feasible to administer in an ED setting. Patients’ self-reported overall GOC were to maintain or improve function with some pain and suffering (53%), live as long as possible with possibility of more pain and suffering (25%), reduce pain and suffering even if it means living for less time (18%), and other (2%). Conclusion(s) Systematically eliciting patients’ overall GOC in a busy, academic ED is feasible and acceptable to patients and RAs. Impact Systematic, real-time documentation of patients’ overall GOC in the ED could facilitate treatment plans aligned with patients’ goals throughout a hospital course. More research is needed to understand how participants’ responses to the GOC survey align with goals elicited during more traditional patient-clinician GOC discussions. Keywords Advanced care planning/shared decision making/Communication and prognostication