Differing Conceptualizations of the Goals of Care Discussion: A Critical Discourse Analysis
Open accessAbstract
Context The goals of care discussion (GOCD) has been positioned as an improvement strategy to address discordance between care decisions made by seriously ill patients and care received. Interventions aimed at improving GOCDs however have had limited success. This may in part be due to the considerable variation in views on the essential components and expected outcomes of a GOCD. This variability, and consequently clinical approaches to GOCDs, may reflect fundamental differences in how the GOCD is conceptualized. Objective To identify and characterize differing conceptualizations of the GOCD. Methods Critical discourse analysis was used to qualitatively examine GOCDs documented for inpatients of 35 Canadian palliative medicine (PM), critical care medicine (CCM) and general internal medicine (GIM) physicians. Patterns in the ways the GOCD had been constructed were characterized by identifying different aspects of the approaches used by clinicians. Results GOCD notes varied in the predominant style and tone (from narrative to biomedical), predominant information source (patient/family to physician), and contribution of the patient's perspective. Notably binary differences were also found in the locus of goals and located either with the patient or with the broad concept of treatments. Although not exclusively, locus of goals tended to be with the patient among PM physicians and with treatments among CCM and GIM physicians. Conclusion These findings offer clinical evidence for differing conceptualizations of the GOCD and orientations to goals as either person-centered or treatment-centered. This phenomenon may be in part discipline-based and has important implications for both clinical practice and training experiences.
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The cost barrier of task-specific model development poses significant challenges for researchers interested in measuring multidimensional constructs whose definitions appropriately differ from study to study.
“This cost barrier poses significant challenges for researchers interested in measuring multidimensional constructs for which definitions are likely to differ appropriately from study to study.37,38,35”
From Assessment of a Zero-Shot Large Language Model in Measuring Documented Goals-of-Care Discussions (2026) · cites this paper as [38]
Cites
Tong, A., Sainsbury, P., & Craig, J. (2007) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzm042 · Cited by 42,509 · see citing works
Sudore, R. L., Lum, H. D., You, J. J., Hanson, L. C., Meier, D. E., Pantilat, S. Z., Matlock, D. D., Rietjens, J. A. C., Korfage, I. J., Ritchie, C. S., et al. (2017) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2016.12.331 · Cited by 1,726 · see citing works
Communication About Serious Illness Care Goals: A Review and Synthesis of Best Practices
Bernacki, R. E., & Block, S. D. (2014) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2014.5271 · Cited by 1,422 · see citing works
Discourse Studies: A Multidisciplinary Introduction
van Dijk, T. A. (2011) · SAGE Publications Ltd eBooks · doi:10.4135/9781446289068 · Cited by 1,129 · see citing works
Shared decision making: Concepts, evidence, and practice
Stiggelbout, A. M., Pieterse, A. H., & de Haes, J. C. J. M. (2015) · Patient Education and Counseling · doi:10.1016/j.pec.2015.06.022 · Cited by 961 · see citing works
Shared Decision Making in ICUs
Kon, A. A., Davidson, J. E., Morrison, W. E., Danis, M., & White, D. B. (2015) · Critical Care Medicine · doi:10.1097/ccm.0000000000001396 · Cited by 574 · see citing works
Curtis, J. R., Downey, L., Back, A. L., Nielsen, E. L., Paul, S. R., Lahdya, A. Z., Treece, P. D., Armstrong, P., Peck, R., & Engelberg, R. A. (2018) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2018.2317 · Cited by 265 · see citing works
Clinician-Family Communication About Patients’ Values and Preferences in Intensive Care Units
Scheunemann, L. P., Ernecoff, N. C., Buddadhumaruk, P., Carson, S. S., Hough, C. L., Curtis, J. R., Anderson, W. G., Steingrub, J. S., Lo, B., Matthay, M. A., et al. (2019) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2019.0027 · Cited by 198 · see citing works
Secunda, K. E., Wirpsa, M. J., Neely, K. J., Szmuilowicz, E., Wood, G., Panozzo, E., McGrath, J., Levenson, A. R., Peterson, J., Gordon, E. J., et al. (2019) · Journal of General Internal Medicine · doi:10.1007/s11606-019-05446-0 · Cited by 134 · see citing works
How Clinicians Discuss Critically Ill Patients’ Preferences and Values With Surrogates
Scheunemann, L. P., Cunningham, T. V., Arnold, R. M., Buddadhumaruk, P., & White, D. B. (2015) · Critical Care Medicine · doi:10.1097/ccm.0000000000000772 · Cited by 110 · see citing works
Kuper, A., Whitehead, C. R., & Hodges, B. D. (2012) · Medical Teacher · doi:10.3109/0142159x.2012.748887 · Cited by 94 · see citing works
Heyland, D. K., Ilan, R., Jiang, X., You, J. J., & Dodek, P. (2015) · BMJ Quality & Safety · doi:10.1136/bmjqs-2015-004567 · Cited by 83 · see citing works
Timing of Initiation of Maintenance Dialysis
Wong, S. P. Y., Vig, E. K., Taylor, J. S., Burrows, N. R., Liu, C., Williams, D. E., Hebert, P. L., & O’Hare, A. M. (2016) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2015.7412 · Cited by 73 · see citing works
Sanders, J. J., Paladino, J., Reaves, E., Luetke-Stahlman, H., Price, R. A., Lorenz, K., Hanson, L. C., Curtis, J. R., Meier, D. E., Fromme, E. K., et al. (2019) · Journal of Palliative Medicine · doi:10.1089/jpm.2019.0335 · Cited by 63 · see citing works
Choosing Wisely For Critical Care: The Next Five
Zimmerman, J. J., Harmon, L. A., Smithburger, P. L., Chaykosky, D., Heffner, A. C., Hravnak, M., Kane, J. M., Kayser, J. B., Lane-Fall, M. B., Matos, R. I., et al. (2021) · Critical Care Medicine · doi:10.1097/ccm.0000000000004876 · Cited by 59 · see citing works
How Effective Is Palliative Care in Improving Patient Outcomes?
Milazzo, S., Hansen, E., Carozza, D., & Case, A. A. (2020) · Current Treatment Options in Oncology · doi:10.1007/s11864-020-0702-x · Cited by 55 · see citing works
Kruser, J. M., Benjamin, B. T., Gordon, E. J., Michelson, K. N., Wunderink, R. G., Holl, J. L., & Schwarze, M. L. (2019) · Critical Care Medicine · doi:10.1097/ccm.0000000000003711 · Cited by 50 · see citing works
Analyzing Talk in the Social Sciences
Bischoping, K., & Gazso, A. (2016) · SAGE Publications Ltd eBooks · doi:10.4135/9781473965454 · Cited by 40 · see citing works
Goals of care: a concept clarification
Stanek, S. (2016) · Journal of Advanced Nursing · doi:10.1111/jan.13243 · Cited by 35 · see citing works
Do We Know What We Mean? An Examination of the Use of the Phrase “Goals of Care” in the Literature
Edmonds, K. P., & Ajayi, T. A. (2019) · Journal of Palliative Medicine · doi:10.1089/jpm.2019.0059 · Cited by 32 · see citing works
McNiff, K. K., Caligiuri, M. A., Davidson, N. E., Farrar, W. B., Fisher, R. I., Glimcher, L. H., Hanners, R. B., Hwu, P., Johnson, C. S., Pisters, P. W. T., et al. (2021) · The Oncologist · doi:10.1002/onco.13850 · Cited by 29 · see citing works
Bickell, N. A., Back, A. L., Adelson, K. B., Gonsky, J. P., Egorova, N., Pintova, S., Lin, J. J., Kozuch, P. S., Bagiella, E., & Smith, C. B. (2020) · JCO Oncology Practice · doi:10.1200/op.20.00040 · Cited by 26 · see citing works
Associations between Reason for Inpatient Palliative Care Consultation, Timing, and Cost Savings
Ernecoff, N. C., Bilderback, A. L., Bellon, J. E., Arnold, R. M., Boninger, M. L., & Kavalieratos, D. (2021) · Journal of Palliative Medicine · doi:10.1089/jpm.2020.0636 · Cited by 21 · see citing works
Should We Practice What We Profess? Care near the End of Life
Pizzo, P. A., & Walker, D. M. (2015) · New England Journal of Medicine · doi:10.1056/nejmp1413167 · Cited by 17 · see citing works
Klement, A., & Marks, S. (2020) · Palliative Medicine Reports · doi:10.1089/pmr.2020.0063 · Cited by 14 · see citing works
The case for routine goals-of-care documentation
Yarnell, C. J., & Fowler, R. (2015) · BMJ Quality & Safety · doi:10.1136/bmjqs-2015-004776 · Cited by 9 · see citing works
Cultures of Practice: Specialty-Specific Differences in End-of-Life Conversations
Morales, A., Schultz, K. C., Gao, S., Murphy, A., Barnato, A. E., Fanning, J. B., & Hall, D. E. (2021) · Palliative Medicine Reports · doi:10.1089/pmr.2020.0054 · Cited by 6 · see citing works
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Wittenberg-Lyles, E. M., Goldsmith, J. V., Chen, C., & Prince‐Paul, M. (2024) · PEC Innovation · doi:10.1016/j.pecinn.2024.100254 · Cited by 20 · see citing works
Murakami, N., Reich, A. J., He, K., Gelfand, S. L., Leiter, R. E., Sciacca, K. R., Adler, J. T., Lu, E., Ong, S., Concepcion, B. P., et al. (2023) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2023.07.013 · Cited by 14 · see citing works
The Duality of “Goals of Care” Language: A Qualitative Focus Group Study With Frontline Clinicians
Reif, M. M., Secunda, K. E., Clapp, J. T., Viglianti, E. M., Mylvaganam, R. J., Peliska, M., Holl, J. L., & Kruser, J. M. (2023) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2023.08.014 · Cited by 12 · see citing works
Simplifying Serious Illness Communication: Preparing or Deciding
Myers, J., Steinberg, L. R., Incardona, N., Simon, J. E., Sanders, J. J., & Seow, H. Y. (2024) · Current Oncology · doi:10.3390/curroncol31100433 · Cited by 10 · see citing works
Self-citationEvolution and current state of Advance Care Planning in Canada
Borenko, C., Simon, J. E., Myers, J., Diedrich, K., Stajduhar, K., Cash, C., Wikjord, N., Cory, S., & Schock, B. (2023) · Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen · doi:10.1016/j.zefq.2023.04.009 · Cited by 9 · see citing works
Self-citationAdvance Care Planning, Shared Decision Making, and Serious Illness Conversations in Onconephrology
Reich, A. J., Reich, J. A., & Mathew, P. F. (2022) · Seminars in Nephrology · doi:10.1016/j.semnephrol.2023.151349 · Cited by 4 · see citing works
Rattner, M., & Cait, C.-A. (2025) · Palliative Care and Social Practice · doi:10.1177/26323524251379910 · Cited by 3 · see citing works
Assessment of a Zero-Shot Large Language Model in Measuring Documented Goals-of-Care Discussions
Lee, R. Y., Li, K. S., Sibley, J., Cohen, T., Lober, W. B., Dotolo, D. G., & Kross, E. K. (2026) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2025.09.025 · Cited by 5 · see citing works
Phenwan, T., Sixsmith, J., McSwiggan, L. C., & Buchanan, D. (2025) · Social Sciences & Humanities Open · doi:10.1016/j.ssaho.2025.101302 · Cited by 2 · see citing works
Goals of care discussions in hospitalised patients: systematic review of randomised trials
DiDiodato, C., Martin, C., Austgarden, D., McLean, J., & DiDiodato, G. (2025) · BMJ Supportive & Palliative Care · doi:10.1136/spcare-2025-005827 · Cited by 1 · see citing works
Pan, Y. (2024) · Journal of Language Teaching · doi:10.54475/jlt.2024.002
Lee, R. Y., Li, K. S., Sibley, J., Cohen, T., Lober, W. B., O’Brien, J., LeDuc, N., Andrews, K. M., Ungar, A., Walsh, J., et al. (2026) · Clinical Trials · doi:10.1177/17407745251405386
Thapa, A., Saylor, M. A., Chehade, M., Waldron, W., Tyson, A. M., Donald, D., Graven, L. J., Cha, G., Moser, D. K., McIlvennan, C. K., et al. (2026) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2026.09.028
- Authors
- Myers, J., Kim, G. L., Bytautas, J., & Webster, F.
- Affiliations
- University of Toronto (CA)
- Western University (CA)
- Corresponding author
- Myers, Jeff
- Venue
- Journal of Pain and Symptom Management
- Publisher
- Elsevier BV
- Published
- 2022-04
- Volume
- 63
- Issue
- 4
- Pages
- 495-502
- ISSN
- 0885-3924 (ISSN-L)
- OpenAlex
- W4200527466
- Cited by
- 13
- References
- 27
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 3 · 2023: 3 · 2022: 1
- FWCI
- 1.52
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Pain and Symptom Management (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 › Health Professions › General Health Professions › Ethics in medical practice
- Keywords
- person-centred care, palliative medicine, intensive care, general internal medicine, patient perspectives
- MeSH terms
- Canada, Communication, Concept Formation, Decision Making, Humans, Inpatients, Patient Care Planning, Physicians
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