A Duty to Plan: Proactive Goals of Care Conversations with Seriously Ill Veterans Who Test Positive for COVID-19

Excerpt

The COVID-19 pandemic is highlighting the importance of proactively planning for, having, and documenting goals of care conversations (GoCC) and developing life-sustaining treatment (LST) plans for seriously ill patients, including high-risk patients diagnosed with COVID-19.^1,2 Proactive GoCC promote a process where patients’ values, goals, and preferences are honored and unwanted treatment is reduced. Veterans Health Administration (VHA) is the largest integrated health care network in the USA that requires the documentation of goals of care and LST plans of high-risk patients. Practitioners conduct GoCC with high-risk patients, in both outpatient and inpatient settings, and document LST decisions using a standardized LST progress note template and order set in the electronic health record (details about GoCC process and documentation are reported elsewhere).² Since 2017, VHA clinicians have conducted 425,013 GoCC with unique high-risk patients or their surrogates. We characterized the extent to which patients had GoCC after COVID-19 diagnosis, their LST decisions, and patient characteristics associated with having a GoCC. …