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Differences in Goals of Care Documentation by Patient Language Preference
Astha Ray1, Enya Zhu2, Hannah Levine3
1Duke University, Durham, NC, USA.
Journal of Pain and Symptom Management
|August 12, 2026
Summary
Patients preferring a language other than English (LOE) had their goals of care (GOC) documentation written closer to death. Interventions are needed to ensure earlier GOC conversations and comprehensive documentation for all patients.
Area of Science:
- Health communication
- Medical documentation
- Health equity
Background:
- Patients with a language other than English (LOE) face communication barriers and challenges in receiving goal-concordant care.
- Goals of care (GOC) conversations and their comprehensive documentation can mitigate these challenges.
Purpose of the Study:
- To compare the documentation of GOC conversations between patients who prefer a language other than English (LOE) and those who prefer English.
- To identify disparities in the timing and content of GOC documentation based on language preference.
Main Methods:
- A retrospective analysis of GOC documentation for adult patients in the last six months of life was conducted.
- Propensity matching by race and ethnicity controlled for factors influencing communication.
- Content analysis of clinical notes compared key GOC documentation components between LOE-preferring and English-preferring patient groups.
Main Results:
- GOC documentation components were similarly frequent between LOE-preferring and English-preferring patients.
- LOE-preferring patients had GOC notes documented significantly closer to death and more often during hospitalization.
- Documentation of cultural, spiritual, and psychosocial needs remained below 50% for both groups.
Conclusions:
- LOE-preferring patients experienced delayed GOC documentation compared to English-preferring patients.
- There is a critical need for targeted interventions to promote earlier and more comprehensive GOC documentation for LOE-preferring populations.
- Improving GOC documentation is essential for equitable, goal-concordant care across diverse patient groups.
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