Establishing care goals and shared decision-making in hospitalized oncology patients: a best practice implementation...

Recognizing the right moment for discussions and defining a patient's care goals is essential. However, aligning these goals across the entire health care team involved in the patient's care can be challenging.

This project aimed to implement best practices to support a shared understanding and care goal concordance among health care professionals caring for hospitalized oncology patients.

This project was guided by the JBI Evidence Implementation Framework, which is based on an audit and feedback process. The project was conducted in a Brazilian tertiary hospital and covered three phases: (1) establishing a working group and conducting a baseline audit; (2) reviewing audit results and implementing improvement strategies; and (3) conducting a follow-up audit to assess improvements in compliance.

In the baseline audit, 13.04% of professionals discussed care goals and 6.25% demonstrated adequate knowledge of the topic. The first follow-up audit revealed a significant increase in compliance (90%). In the second follow-up audit, compliance increased to 96%, while the third follow-up audit maintained compliance at 96.15%, improving professionals' knowledge to 81.25%. Although the perception of therapeutic obstinacy increased to 78.13%, 53.13% of professionals reported moral distress.

The marked improvement in compliance with best practices in aligning care goals not only enhanced quality of care but also strengthened the team's confidence in discussing care. To ensure the sustainability of these initiatives, ongoing leadership support, team engagement, regular training, and periodic audits are essential. The project demonstrated that educational and structural interventions can positively affect clinical practice, particularly in challenging contexts such as oncology.