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Common mistakes and evidence-based approaches in goals-of-care conversations for seriously ill older adults in
Katharine A Manning1, Jason Bowman2,3,4, Shunichi Nakagawa5
1Department of Internal Medicine, Division of Cardiovascular Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
Abstract:
For older adults with serious, life-limiting illnesses near the end of life, clinicians frequently face difficult decisions about the medical care they provide because of clinical uncertainty. This difficulty is further complicated by unique challenges and medical advancements for patients with advanced heart diseases. In this article, we describe common mistakes encountered by clinicians when having goals-of-care conversations (e.g. conversations between clinicians and seriously ill patients/surrogates to discuss patient's values and goals for clinical care near the end of life.). Then, we delineate an evidence-based approach in goals-of-care conversations and highlight the unique challenges around decision-making in the cardiac intensive care unit.
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