Interventions Promoting Goals of Care Conversations in Serious Illness: A Narrative Review

Goals of care (GOC) discussions are critical conversations between patients, families, and clinicians to ensure medical treatment aligns with patients' values/preferences, especially in the context of serious illness. Despite their importance in enhancing patients' quality of life (QOL) and aligning care plans with values/preferences, GOC discussions occur infrequently due to systemic, clinician, and patient-level barriers. We sought to conduct an updated review of the literature highlighting recent interventions aimed at improving GOC discussions, as summarizing these advancements could help inform clinical practice.

We conducted a robust, systematic narrative review to analyze clinical trials from 2010 to 2025 focused on improving GOC discussions among seriously ill patients (defined as individuals with life-limiting illness). Eligible studies included randomized and nonrandomized trials that reported patient-level outcomes. We identified relevant articles by searching PubMed, Web of Science, CINAHL, and Embase databases, extracting data regarding study design, setting, sample, intervention details, and outcomes (mapped in a tabular format to facilitate comparison).

We identified 41 eligible studies conducted in diverse settings (n = 21, 51.2% across hospitals) and serious illness types (n = 21, 51.2% across multiple serious illness), predominantly from the United States (n = 31, 75.6%). Most studies were randomized controlled trials (n = 28; 68.3%), focusing on patient, clinician, system, or combined interventions to enhance GOC discussions. Patient-focused interventions increased readiness and documentation but showed mixed results on clinical outcomes, such as QOL. Clinician and system interventions improved documentation and conversation quality but had inconsistent impacts on healthcare utilization. Combined interventions showed improvements in communication but not consistently in QOL or healthcare utilization.

This review highlights the robustness and diversity of GOC interventions, emphasizing the trade-offs between scalability, depth, and patient-centeredness. While interventions appeared to increase GOC discussions and documentation, their impact on downstream patient and caregiver outcomes remains limited. Future research should refine measures and quality indicators to better capture the impact of GOC discussions on patient and family well-being, while considering proximal process outcomes and downstream health outcomes.