Uncovering Psychosocial Contexts in Goals of Care Conversations: A Qualitative Study in a Multi-Centered Randomized...

Patients often struggle with psychological and social stressors that accompany life-limiting chronic illness. Because psychosocial concerns may be conveyed through emotional sentiments, this study aimed to identify emotional expressions to describe psychosocial contexts communicated during goals of care conversations.

This qualitative study evaluated 26 transcripts of goals of care conversations using a "goals of communication guide" from the ADvancing system Alleviation with Palliative Treatment (ADAPT) trial in VA Eastern Colorado and Puget Sound Health Systems. Using an inductive and deductive approach, a codebook was developed to examine participants' expressed emotions regarding overall goals of care, illness, end of life, and family involvement. Major themes around psychosocial concerns were summarized.

Four themes on psychosocial contexts in goals of care conversations emerged, with instances of both positive and negative affect. Participants commonly discussed contexts relating to: acceptance of illness, the feeling of being a burden; illness transitions; and suffering from disease.

Unprompted within these conversations, patient emotional sentiments in goals of care conversations highlight psychosocial contexts important to patient values and preferences around treatment decisions.

Emphasis on clinician recognition of these psychosocial contexts may help clinicians better support and elicit patient goals and preferences.