Increasing goals of care conversations in primary care: Study protocol for a cluster randomized, pragmatic,...

Area of Science:

• Health Services Research
• Implementation Science
• Clinical Communication

Background:

• Goals of care conversations are crucial for aligning medical decisions with seriously ill patients' values.
• Outpatient goals of care conversations are underutilized in the Veterans Affairs (VA) healthcare system, with most occurring during inpatient stays.
• Effective strategies are needed to promote primary care-based goals of care discussions.

Purpose of the Study:

• To evaluate the effectiveness of patient and clinician implementation strategies on documenting goals of care conversations.
• To compare different sequences and combinations of implementation strategies.
• To explore how patient and site factors influence implementation success.

Main Methods:

• A cluster randomized, sequential, multiple assignment trial involving primary care clinicians and high-risk patients across three VA healthcare system sites.
• Enrollment of primary care clinicians with low goals of care conversation rates and high-risk patients (top 10th percentile for hospitalization/death).
• Sequential implementation strategies with increased intensity for non-responders, targeting both clinicians and patients, alongside mixed-methods evaluation.

Main Results:

• This section is not applicable as the abstract describes a planned study, not results.

Conclusions:

• The study will determine the impact of various implementation strategy sequences and combinations on primary care documentation of goals of care conversations.
• Findings will inform policy decisions for the VA National Center for Ethics in Health Care and Office of Primary Care regarding outpatient goals of care conversations.