Goals of Care for the Critically Injured Trauma Patient

Furiel AE, Putnam JS. Patients with tracheostomies: goals of management. Prim Care. 1978;5(3):557–67.

Article  CAS  PubMed  Google Scholar 

Secunda K, Wirpsa MJ, Neely KJ, Szmuilowicz E, Wood GJ, Panozzo E, et al. Use and meaning of “goals of care” in the healthcare literature: a systematic review and qualitative discourse analysis. J Gen Intern Med. 2019;35(5):1559–66.

Article  PubMed  PubMed Central  Google Scholar 

Norton SA, Metzger M, DeLuca J, Alexander SC, Quill TE, Gramling R. Palliative care communication: linking patients’ prognoses, values and goals of care. Res Nurs Health. 2013;36(6):582–90.

Article  PubMed  Google Scholar 

Klement A, Marks S. The pitfalls of utilizing “goals of care” as a clinical buzz phrase: a case study and proposed solution. Palliat Med Rep. 2020;1(1):216–20.

Article  PubMed  PubMed Central  Google Scholar 

Cassel EJ. The nature of suffering and the goals of medicine. N Engl J Med. 1982;306(11):639–45.

Article  CAS  PubMed  Google Scholar 

Stanek S. Goals of care: a concept clarification. J Adv Nurs. 2017;73(6):1302–14.

Article  PubMed  Google Scholar 

Bern-Klug M. A framework for categorizing social interactions related to end-of-life care in nursing homes. Gerontologist. 2009;49:495–507.

Article  PubMed  PubMed Central  Google Scholar 

Sudore RL, Lum HD, You JJ, Hanson LC, Meier DE, Pantilat SZ, et al. Defining advance care planning for adults: a consensus definition from a multidisciplinary Delphi panel. J Pain Symptom Manage. 2017;53(5):821–32.

Article  PubMed  PubMed Central  Google Scholar 

Myers J, Cosby R, Gzik D, Harle I, Harrold D, Incardona N, et al. Provider tools for advance care planning and goals of care discussion: a systematic review. Am J Hosp Palliat Med. 2018;35(8):1123–32.

Article  Google Scholar 

Udelsman BV, Lee KC, Traeger LN, Lillemoe KD, Chang DC, Cooper Z. Clinician-to-clinician communication of patient goals of care within a surgical intensive care unit. J Surg Res. 2019;240:80–8.

Article  PubMed  Google Scholar 

Stone MJ. Goals of care at the end of life. Proc (Bayl Univ Med Cent). 2001;14(2):134–7.

CAS  PubMed  Google Scholar 

Schwarze ML, Bradley CT, Brasel KJ. Surgical “buy-in”: the contractual relationship between surgeons and patients that influences decisions regarding life-supporting therapy. Crit Care Med. 2010;38(3):843–8.

Article  PubMed  PubMed Central  Google Scholar 

O’Connell K, Maier R. Palliative care in the trauma ICU. Curr Opin Crit Care. 2016;22(6):584–90.

Article  PubMed  Google Scholar 

Turnbull AE, Hartog CS. Goal-concordant care in the ICU: a conceptual framework for future research. Intensive Care Med. 2017;43:1847–9.

Article  PubMed  PubMed Central  Google Scholar 

Weissman DE, Meier DE. Identifying patients in need of a palliative care assessment in the hospital setting: a consensus report from the centers to advance palliative care. J Pall Med. 2011;14:17–23.

Article  Google Scholar 

Cook MR. Goals of care understanding the outcomes that matter most. Surg Clin North Am. 2019;99(5):833–47.

Article  PubMed  Google Scholar 

Temel J, Greer JA, Admane S, Gallagher ER, Jackson VA, Lynch TJ, et al. Longitudinal perceptions of prognosis and goals of therapy in patients with metastatic non-small-cell lung cancer: results of a randomized study of early palliative care. J Clin Oncol. 2011;29:2319–26.

Article  PubMed  Google Scholar 

Parikh RB, Kirch RA, Smith TJ, Temel JS. Early specialty palliative care: translating data in oncology into practice. N Engl J Med. 2013;369:2347–51.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Bernacki RE, Block SD. Communication about serious illness care goals a review and synthesis of best practices. JAMA Intern Med. 2014;174(12):1994–2003.

Article  PubMed  Google Scholar 

Zimmerman JJ, Harmon LA, Smithburger PL, Chaykosky D, Heffner AC, Hravnak M, et al. Choosing wisely for critical care: the next five. Crit Care Med. 2021;49(3):472–481. The Society of Critical Care Medicine recently released their latest “Choosing Wisely” guidelines which emphasize the importance of goals of care. They recommend clinicians not to continue life-sustaining treatments for patients at high risk for death or severely impaired functional recovery without offering patients and their families the alternative of care focused entirely on comfort. Furthermore, they recommend clinicians not to provide care that is discordant with the patient’s goals and values.

Halpern SD. Goal-concordant care—searching for the holy grail. N Engl J Med. 2019;381:1603–6.

Article  PubMed  Google Scholar 

Pierce JG, Ricon R, Rukmangadhan S, Kim M, Rajasekar G, Nuno M, et al. Adherence to the TQIP palliative care guidelines among patients with serious illness at a level I trauma center in the US. JAMA Surg. 2022;157(12):1–8. This was a retrospective cohort study completed at a level 1 trauma center and the objective was to measure adherence to the American College of Surgeons (ACS) Trauma Quality Improvement Project (TQIP) Palliative Care Best Practice Guidelines. This study demonstrated that only 18.9% of trauma patients with serious illness had goals of care addressed within 72 h of admission, as currently recommended by ACS TQIP national guidelines. Only one in four critically injured patients had goals of care addressed at all during their hospital stay. This study highlights a critical need to improve approaches to establishing and addressing goals of care in critically injured patients.

American College of Surgeons (ACS) Trauma Quality Improvement Project (TQIP) Palliative Care Best Practices Guidelines. Released October 2017. Available at: https://www.facs.org/media/g3rfegcn/palliative_guidelines.pdf. Accessed 19 Sept 2023.

Edsall A, Howard S, Dewey EN, Siegel T, Zonies D, Brasel K, et al. Critical decisions in the trauma intensive care unit: are we practicing primary palliative care? J Trauma Acute Care Surg. 2021;91(5):886–890. This was a single-center retrospective observational study conducted at a level 1 trauma center and designed to test the hypothesis that a primary palliative care–based practice would improve adherence to national guidelines for trauma patients with respect to timing of goals of care discussions. The authors examined timing of goals of care discussions, transition to comfort measures only, and involvement of specialty palliative care services for all injured patients who died at their facility over a 5-year study period. They showed that the trauma ICU team led 98% of goals of care discussions, and specialty palliative care was only used in 7% of cases. A primary palliative care–based practice improved adherence to national guidelines.

Kim DY, Lissauer M, Martin N, Brasel K and the Critical Care Committee of the AAST. Defining the surgical critical care research agenda: results of a gaps analysis from the Critical Care Committee of the American Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2020;88:320–329.

Dunn GP, Martensen R, Weissman D. Surgical palliative care: a resident’s guide. Available at: https://www.facs.org/media/kcfn4mux/surgicalpalliativecareresidents.pdf. Accessed 19 Sept 19 2023.

Taylor LJ, Nabozny MJ, Steffens NM, Tucholka JL, Brasel KJ, Johnson SK, et al. A framework to improve surgeon communication in high-stakes surgical decisions best case/worst case. JAMA Surg. 2017;152(6):531–8.

Article  PubMed  PubMed Central  Google Scholar 

Kruser JM, Taylor LJ, Campbell TC, Zelenski A, Johnson SK, Nabozny MJ, et al. “Best case/worst case”: training surgeons to use a novel communication tool for high-risk acute surgical problems. J Pain Symptom Manage. 2017;53(4):711–9.

Article  PubMed  PubMed Central  Google Scholar 

Berlin A. Goals of care and end of life in the ICU. Surg Clin N Am. 2017;97:1275–90.

Article  PubMed  Google Scholar 

Ethical guidelines for the anesthesia care of patients with do-not-resuscitate orders or other directives that limit treatment. American Society of Anesthesiologists. Available at: https://www.asahq.org/standards-and-practice-parameters/statement-on-ethical-guidelines-for-the-anesthesia-care-of-patients-with-do-not-resuscitate-orders. Accessed 19 Sept 2023.

WHO definition of palliative care. Available at https://www.who.int/cancer/palliative/definition/en/. Accessed 19 Sept 2023.

Kodadek LM. Ethical challenges when establishing goals of care in the acute care surgical setting. J Clin Ethics. 2022;33(2):146–150. This article highlights ethical challenges associated with establishing goals of care in acute care surgical settings. Hypothetical case examples are offered to highlight difficulties more commonly encountered in trauma or acute care settings including the time-sensitive nature of treatment, lack of patient capacity, need for a surrogate, and lack of foundational rapport between patient and surgeon. This article is helpful to understand goals of care in clinical context.

Pope TM. Legal fundamentals of surrogate decision making. Chest. 2012;141(4):1074–81.

Article  PubMed  Google Scholar 

Morrison RS, Meier DE, Arnold RM. What’s wrong with advance care planning? JAMA. 2021;326(16):1575–6. This recent opinion piece highlights pitfalls of advance care planning and makes a case for the importance of goals of care and shared decision-making to address current health issues and ensure care provided aligns with patient values and priorities.

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