Key domains of inpatient goals-of-care discussions and their impact on patient and surrogate outcomes

The National Institute on Aging awarded the University of Washington $108,476 under NIH Project Grant F32AG101798 on February 12, 2027, to support research examining the relationship between electronic health record-documented goals-of-care discussions and patient and surrogate outcomes in hospitalized older adults.

The research investigates how inpatient goals-of-care discussions documented in electronic health records relate to three patient- and surrogate-reported outcomes: quality of communication, shared decision-making, and goal-concordant care. The study leverages data from a randomized trial of 617 older hospitalized patients with chronic, life-limiting illness, including 77 patients with Alzheimer's disease and related dementias. The project employs a mixed-methods design combining quantitative analysis of the association between documented goals-of-care discussions and patient outcomes with exploratory qualitative work to identify key domains of effective discussions and characterize patterns across patient populations with and without dementia.

The award falls under the Aging Research program (CFDA 93.866), which supports biomedical, social, and behavioral research directed toward understanding aging processes and diseases affecting older populations, with emphasis on Alzheimer's disease and related dementias.

The University of Washington Office of Sponsored Programs serves as the recipient. Performance occurs in Seattle, Washington, with an ultimate completion date of February 11, 2028.

Abstract

Research: older patients with chronic, life-limiting illnesses such as alzheimer's disease and related dementias (ADRD) are at substantial risk of receiving goal-discordant medical care during hospitalization. Inpatient goals-of-care discussions (GOCDS) are an important communication tool that can help align care with an individual's goals, values, and treatment preferences. Few prior studies have investigated the impact of inpatient GOCDS on patient- and surrogate-centered outcomes. There is additionally a lack of broad consensus regarding the salient domains that constitute effective GOCDS. The electronic health record (EHR) offers a pragmatic and efficient approach to rigorously study and optimize inpatient GOCDS. Further investigation into the key domains and effects of EHR-documented GOCDS is needed to address these knowledge gaps and improve outcomes for hospitalized older adults, particularly those with ADRD. This mixed-methods study will examine the relationship between EHR-documented GOCDS and three patient- and surrogate-reported outcomes: quality of communication, shared decision-making, and goal-concordant care. This study will leverage data from a randomized trial of 617 older, hospitalized patients with chronic, life- limiting illness, including 77 patients with ADRD. Aim 1 involves quantitative analysis of the association between EHR-documented GOCDS and these outcomes. Aims 2A and 2B involve a mixed-methods exploratory sequential design to identify key domains of EHR-documented GOCDS, characterize patterns in patients with and without ADRD, and evaluate their association with these same outcomes. This work serves the broader objective of improving inpatient GOCDS and patient-centered outcomes for at-risk populations. Candidate and environment: DR. Alison uyeda is an early career physician investigator who seeks to improve communication and goal-concordant care for patients experiencing serious illness. With interdisciplinary support from DR. Erin kross (MPI of the parent trial and nationally acclaimed palliative care researcher), DR. Lyndia brumback (BIOSTATISTICIAN), and DR. Danae dotolo (qualitative and mixed-methods expert), she will conduct this research project within a structured fellowship training plan. Skills gained in biostatistical techniques, methodological integration, and scientific presentation will be instrumental to her achievement of career goals and transition towards independent research. Study findings will inform a future mentored career development award for a delphi study to build evidence-based consensus on the key domains of inpatient GOCDS, and ultimately, intervention trials to improve patient-centered outcomes for hospitalized patients.