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

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

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.

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."

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.

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

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