Riedy Hannah, Lyons Kiira, Casarett David J, Jordan Megan, Monroe Bryan S, Eckert Erin, Ma Jessica E
Duke University School of Medicine (H.R.), Durham, North Carolina, USA.
Division of Geriatrics and Palliative Care (K.L., D.J.C., E.E., J.E.M.), Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
J Pain Symptom Manage. 2025 Aug;70(2):e144-e158. doi: 10.1016/j.jpainsymman.2025.04.014. Epub 2025 May 5.
Documented goals-of-care (GOC) conversations promote goal-concordant care; few studies have evaluated the comprehensiveness of this documentation within pediatrics.
To evaluate the content of pediatric GOC documentation within a health system.
GOC notes were written between August 7, 2016 and September 8, 2023 for patients ≤18 years old at one academic health system. Notes were identified by related GOC-specific "text markers" in the electronic health record. A pediatric GOC codebook was adapted from existing frameworks. Notes were evaluated for the presence of each of seven components from the codebook. Misfiled GOC notes were excluded from analysis.
A total of 429 notes were written in the inpatient or outpatient setting across pediatric specialties. Most notes were written by the palliative care service (77.9%) and by attending physicians (77.4%). Most patients were <1 (41.0%) or 1-6 years old (23.4%), non-Hispanic (82.9%), and spoke English (90.2%). Of the 91 patients (44.4%) who died before September 8, 2023, the median number of days between their first GOC note and death was 10.3 days (interquartile range (IQR) 1.6-49.0). The median number of GOC components per note was 5.0 out of 7 possible (IQR 4.0-5.5). Frequently documented GOC components were discussion participants (98.1%), goals/fears/priorities (87.6%), and treatment decisions (85.3%). Infrequent components were end-of-life care planning (33.3%) and information preferences (9.8%).
Pediatric GOC notes included most GOC components; however, number of components may not reflect the quality and depth of actual discussions. Future research should assess GOC documentation for pediatric patients from diverse backgrounds.
有记录的照护目标（GOC）对话可促进目标一致的照护；很少有研究评估儿科领域此类记录的全面性。
评估一个医疗系统内儿科GOC记录的内容。
2016年8月7日至2023年9月8日期间，为某学术医疗系统中18岁及以下的患者撰写了GOC记录。通过电子健康记录中相关的GOC特定“文本标记”来识别记录。从现有的框架改编了一个儿科GOC编码手册。根据编码手册中的七个组成部分对记录进行评估。分析时排除了归档错误的GOC记录。
在儿科各专科的住院或门诊环境中总共撰写了429份记录。大多数记录由姑息治疗服务团队（77.9%）和主治医师（77.4%）撰写。大多数患者年龄小于1岁（41.0%）或1至6岁（23.4%），非西班牙裔（82.9%），说英语（90.2%）。在2023年9月8日前死亡的91名患者（44.4%）中，从他们的第一份GOC记录到死亡的天数中位数为10.3天（四分位间距（IQR）1.6 - 49.0）。每份记录中GOC组成部分的中位数为7个可能组成部分中的5.0个（IQR 4.0 - 5.5）。经常记录的GOC组成部分是讨论参与者（98.1%）、目标/担忧/优先事项（87.6%）和治疗决策（85.3%）。不常出现的组成部分是临终照护计划（33.3%）和信息偏好（9.8%）。
儿科GOC记录包含了大多数GOC组成部分；然而，组成部分的数量可能无法反映实际讨论的质量和深度。未来的研究应评估来自不同背景的儿科患者的GOC记录。
