Center for Goal Concordant Care Clinical Operations
Nico Nortj¨¦, Ph.D.
Executive Director
- Departments, Labs and Institutes
- Departments and Divisions
- Center for Goal Concordant Care
Goal concordant care ensures the medical care provided to patients aligns with their values, preferences and goals, particularly in times of serious or life-limiting illness. Goal Concordant care has been identified by the National Academy of Medicine, MD Anderson Cancer Center, and the Alliance of Dedicated Cancer Centers as a key priority in providing patient-centered care. Addressing matters such as the aggressiveness of treatment, hoped-for functional outcomes, and ability to participate in future events, will guide conversations between patients and clinicians at MD Anderson.
Focusing on clinical operations, the Center for Goal Concordant Care ensures that MD Anderson uses data, patient feedback, and innovative techniques for better aligning patient values and wishes with treatment options. The Center promotes holding and documenting important conversations about patient values and integrating these into their care plans. This helps to improve patient satisfaction, reduce unwarranted interventions and admissions, and support patient-centered care.
Operationalizing Goal Concordant Care at MD Anderson and around the world
The Center for Goal Concordant Care aims to model and instill a patient-centered culture that supports a patient¡¯s healthcare journey through a bi-directional patient-provider collaboration along with high-quality, goal-concordant care delivery at MD Anderson and beyond. The program supports the patient, their family and their care teams to engage in meaningful, timely and empathetic conversations about the patient¡¯s prognosis, values and wishes.
Our Road Map: Advancing Goal Concordant Care
At the Center for Goal Concordant Care, we believe that high-quality care starts with understanding what matters most to patients. Our structured, three phase approach guides clinical teams and patients through a process that ensures medical decisions align with patient values and goals.
Prepare
Before any meaningful conversation can happen, we focus on preparation:
- Identify patients who may benefit from a Goals of Care discussion
- Team preparation ensures that providers are equipped with clinical context and communication strategies
- Patient preparation includes materials or outreach to help patients reflect on their values and goals ahead of the visit
Converse
This step is the heart of goal-concordant care:
- A structured conversation allows patients and care teams to explore values, preferences, and clinical realities in a clear, compassionate way
- A structured documentation guide helps ensure that what¡¯s discussed is recorded accurately and can be shared across the care team
Support
Goal-concordant care is an ongoing commitment, not a one-time event. Ongoing support includes:
- Psychosocial follow-up to address emotional, spiritual, and practical concerns
- Assistance with advance directives and care planning
- Decision aids to support patients in complex choices
- Educational videos that reinforce key messages
Goals of Care Decision-Making
This framework outlines a stepwise, patient-centered approach to making medical decisions in the setting of serious illness or complex care. It ensures that treatment choices are guided by what matters most to each individual, while grounded in the medical context.
Patient values and priorities
The process begins by exploring what the patient values most.
- These may include comfort, independence, meaning, or longevity
- Cultural beliefs, personal goals, and definitions of quality of life are essential to understand
- Reservations, hopes, and preferences help define what matters most
Goals of care
Once patient values are clear, they are translated into broad care goals.
- These are guiding objectives tailored to the current medical context
- Examples include prolonging life, improving function, relieving suffering, or preparing for end-of-life
Intervention decisions
Specific medical decisions are made to match the patient¡¯s care goals.
- Examples include surgery, hospitalization, palliative care, or hospice
- These decisions reflect what is medically feasible and aligned with patient priorities
Clinical context and medical intervention options are key external influences throughout the process:
- Clinical context includes diagnosis, prognosis, and disease trajectory
- Medical options refer to what is possible and effective
- These factors shape the conversation and may evolve over time