Using Design Thinking to Promote Goals of Care Conversations With Seriously Ill Patients.

BACKGROUND

Goals of care (GOC) conversations can improve serious illness outcomes such as pain and symptom management and patient satisfaction.

PROBLEM

However, we recognized that very few Duke Health patients who died had a GOC conversation documented in the designated electronic health record (EHR) tab. Therefore, in 2020, we set a target that all Duke Health patients who died should have had a GOC conversation documented in a designated EHR tab in the last 6 months of life.

INTERVENTION

In developing a strategy to promote GOC conversations, we used two interwoven approaches. The first was RE-AIM, a model for designing, reporting and evaluating health behavior research. The second was less of a model than a way of approaching problems, known as "design thinking."

OUTCOMES

We employed both of these approaches in a system-wide effort that achieved a 50% prevalence of GOC conversations in the last 6 months of life.

KEY MESSAGE

In combination, simple interventions can have a significant impact on behavior change in an academic health system.

LESSONS LEARNED

We found that design thinking techniques offered a useful bridge between RE-AIM strategy and clinical.