After a Canada-wide competition, a team of researchers at Royal Victoria Regional Health Centre (RVH) have received a $668,968 grant to help reduce the administrative burden physicians face when conducting goals of care discussions.
Led by RVH intensivist and Chief Research Scientist, Dr. Giulio DiDiodato, the two-year project – made possible through the Health Care Unburdened Grant program established by the Canadian Medical Association, MD Financial Management Inc., and Scotiabank, – will support the dissemination of an innovative e-tool that facilitates a new clinical standard for how hospitals, family health teams, and long-term care homes conduct goals of care discussions.
Goals of care discussions are conversations between patients, families, and doctors and are vital in understanding the patient’s values, preferences, and desired outcomes for their medical treatment.
“Knowing what is most important to our patients in terms of their health, quality of life, and personal values is considered an essential component of high-quality care,” says Dr. Chris Martin, co-applicant on the grant and RVH’s Chief of Critical Care. “This is especially important for life-threatening illnesses, where goals of care discussions may focus on more complex treatments that prolong life, but may also involve significant burdens or risks.”
Despite the critical nature of these conversations, there is no systematic or standardized practice for conducting goals of care discussions. And of the few tools that have been developed, none can be applied across all diseases or offer validated prognostic models that would ensure widespread use throughout the health system.
“Currently, doctors carry the sole responsibility for leading goals of care discussions, which should occur for every patient encounter involving a major clinical decision,” says Dr. DiDiodato. “But with so many patients to see, it can be difficult to find time to have these very personal, very empathetic conversations.”
Even the most skilled doctors may still struggle to find the right words at the right time when discussing sensitive and emotional topics with their patients and families.
“With the use of our e-tool to guide the process, any trained caregiver can now initiate and navigate goals of care discussions for any condition in a safe and confident manner,” adds Dr. DiDiodato. “We are excited to potentially save hundreds of thousands of administrative hours every year for physicians across Canada.”
Over the past five years, Dr. DiDiodato and the team at RVH have developed and validated these new clinical standards, first through a small pilot study, then through a large randomized clinical trial supported through a grant from the Alectra Fund for Health & Social Innovation in 2022.
“Building on these initial successes, the Health Care Unburdened Grant now paves the way for us to share this homegrown innovation with our healthcare peers across the province,” says Dr. Jesse McLean, RVH’s Director of Research and co-author on the grant. “We will also be working with several community partners to help spread the tool, including teams at Georgian College’s School of Computer Studies and Henry Bernick Entrepreneurship Centre, as well as Barrie and Area Ontario Health Team, and the University of Toronto’s Family Medicine Teaching Unit located at RVH”.