Assessing Perceptions of Positive and Negative Content within Goals of Care Notes

Clinician documentation of negative content in electronic health record notes is known to exist.

To assess community members and clinicians perceptions about negative content within goals of care conversation (GOCC) notes.

We conducted a mixed-methods study of community member and clinician perspectives about positive, neutral, and negative content within GOCC notes written by clinicians across 14 hospitals. We used thematic analysis to identify perceptions of positive and negative content.

A total of 12 participants reviewed 65 GOCC notes, 6 community members (50%), and 6 clinicians (50%). Participants were 33% Black, 33% White, 25% Asian, and 17% Hispanic/Latino with median age 33 years (range 22-68). While community members and clinicians shared similar perceptions about positive content within GOCC notes (i.e., kind language, description of patient values, and clear documentation), they differed in their perceptions about negative content within GOCC notes. Community members perceived 1) concerns about patient or family understanding, 2) descriptions of bad patient health, and 3) a lack of empathy as negative content. Clinicians perceived 1) poor writing, 2) lack of important information, and 3) clinician judgmental descriptions about patients and families as negative content.

While both community members and clinicians identified negative content within GOCC notes, our findings demonstrate low agreement among these groups about what constitutes negative content within GOCC notes. Our findings may be used to guide clinicians in how best to document GOCC notes read by clinicians, patients, and families.