Department of Medicine (D.C.), Duke University School of Medicine Duke Health, Durham, North Caroline, USA.
Duke Health (K.L., S.I.), Durham, North Caroline, USA.
J Pain Symptom Manage. 2023 Aug;66(2):e275-e281. doi: 10.1016/j.jpainsymman.2023.04.010. Epub 2023 Apr 24.
Goals of care (GOC) conversations can improve serious illness outcomes such as pain and symptom management and patient satisfaction.
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.
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."
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.
In combination, simple interventions can have a significant impact on behavior change in an academic health system.
We found that design thinking techniques offered a useful bridge between RE-AIM strategy and clinical.
目标关怀（GOC）对话可以改善重病患者的结局，如疼痛和症状管理以及患者满意度。
然而，我们发现，在指定的电子健康记录（EHR）标签中，只有极少数在杜克健康去世的患者记录了 GOC 对话。因此，在 2020 年，我们设定了一个目标，即在生命的最后 6 个月内，所有在杜克健康去世的患者都应该在指定的 EHR 标签中记录 GOC 对话。
在制定促进 GOC 对话的策略时，我们使用了两种相互交织的方法。第一种是 RE-AIM，这是一种设计、报告和评估健康行为研究的模型。第二种则更像是一种解决问题的方法，称为“设计思维”。
我们在全系统范围内采用了这两种方法，在生命的最后 6 个月里，实现了 50%的 GOC 对话普及率。
在学术医疗体系中，简单的干预措施结合使用可以对行为改变产生重大影响。
我们发现，设计思维技术为 RE-AIM 策略和临床之间提供了有用的桥梁。
