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Cited by 1,422Palliative Care and End-of-Life IssuesPatient-Provider Communication in HealthcarePalliative and Oncologic Care

Communication About Serious Illness Care Goals: A Review and Synthesis of Best Practices

Bernacki, Rachelle E., Block, Susan D.·2014·JAMA Internal Medicine
DOI 10.1001/jamainternmed.2014.5271
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Abstract

An understanding of patients' care goals in the context of a serious illness is an essential element of high-quality care, allowing clinicians to align the care provided with what is most important to the patient. Early discussions about goals of care are associated with better quality of life, reduced use of nonbeneficial medical care near death, enhanced goal-consistent care, positive family outcomes, and reduced costs. Existing evidence does not support the commonly held belief that communication about end-of-life issues increases patient distress. However, conversations about care goals are often conducted by physicians who do not know the patient, do not routinely address patients' nonmedical goals, and often fail to provide patients with sufficient information about prognosis to allow appropriate decisions; in addition, they tend to occur so late in the patient's illness that their impact on care processes is reduced. This article (1) reviews the evidence and describes best practices in conversations about serious illness care goals and (2) offers practical advice for clinicians and health care systems about developing a systematic approach to quality and timing of such communication to assure that each patient has a personalized serious illness care plan. Best practices in discussing goals of care include the following: sharing prognostic information, eliciting decision-making preferences, understanding fears and goals, exploring views on trade-offs and impaired function, and wishes for family involvement. Several interventions hold promise in systematizing conversations with patients about serious illness care goals: better education of physicians; systems to identify and trigger early discussions for appropriate patients; patient and family education; structured formats to guide discussions; dedicated, structured sections in the electronic health record for recording information; and continuous measurement. We conclude that communication about serious illness care goals is an intervention that should be systematically integrated into our clinical care structures and processes.

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  • Goals-of-care discussions are an important process measure in palliative care research and likely mediate the delivery of patient-centered, goal-concordant care.

    “Goals-of-care discussions are an important process measure in palliative care research, and likely mediate the delivery of patient-centered, goal-concordant care.6–8”

    From Assessment of a Zero-Shot Large Language Model in Measuring Documented Goals-of-Care Discussions (2026) · cites this paper as [6]

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Authors
Bernacki, R. E., & Block, S. D.
Affiliations
Brigham and Women's Hospital (US)
ORCID
Venue
JAMA Internal Medicine
Publisher
American Medical Association (AMA)
Published
2014-12-01
Volume
174
Issue
12
Pages
1994
ISSN
2168-6106 (ISSN-L)
DOI
10.1001/jamainternmed.2014.5271
OpenAlex
W2095880617
Cited by
1,422
References
103
Citations by year
2026: 139 · 2025: 120 · 2024: 145 · 2023: 159 · 2022: 121 · 2021: 153 · 2020: 138 · 2019: 150 · 2018: 97 · 2017: 101 · 2016: 68 · 2015: 29 · 2014: 2
FWCI
66.04
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
Keywords
goals of care, serious illness, end-of-life communication, prognostic information, advance care planning, family involvement, physician training, electronic health records, quality of life, timing of discussions
MeSH terms
Communication, Decision Making, Humans, Palliative Care, Patient Care Planning, Physician-Patient Relations, Prognosis, Quality of Life, Terminal Care, Advance Directives, Practice Guidelines as Topic, Evidence-Based Medicine, Advance Care Planning, Electronic Health Records

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