Differences in Goals of Care Documentation by Patient Language Preference

Patients who use a language other than English (LOE) face barriers to communication and goal-concordant care, which can be improved through the conduct and comprehensive documentation of goals of care (GOC) conversations.

To compare GOC documentation between LOE-preferring and English-preferring patients.

We evaluated GOC documentation written in the last 6 months of life for adults who died between January 10, 2021 and January 10, 2024 at a tertiary health system. To control for factors which may impact communication, patients with a non-English language preference were matched by race and ethnicity to English-preferring patients using propensity matching. Content analysis was used to compare key components of GOC documentation in the notes. Statistical comparisons involved chi-square tests.

Among 244 patients (122 LOE, 122 English), we reviewed 687 notes. Patients were on average 65.8 years old, 49.2% female, 24.6% Caucasian, and 50.8% Hispanic. GOC component frequency was similar between patient groups. Although cultural/spiritual needs and clinician view of prognosis were more frequently documented for LOE-preferring patients (P = 0.006, 0.009, respectively), overall documentation of cultural, spiritual, and psychosocial needs was less than 50%. While both groups had a median of five out of 10 components documented across notes, LOE-preferring patients often had their first note written over a month closer to death than English-preferring patients.

LOE-preferring patients were more likely to have their GOC notes written closer to death and while hospitalized compared to English-preferring patients. Additional interventions are needed to support earlier GOC conversations and improve comprehensive documentation.