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Background: Patients with a life‐limiting illness (LLI) requiring hospitalisation have a high likelihood of deterioration and 12‐month mortality. To avoid non‐aligned care, we need to understand our patients' goals and values. Aim: To describe the association between the implementation of a shared decision‐making (SDM) programme and documentation of goals of care (GoC) for hospitalised patients with LLI. Methods: A prospective longitudinal interventional study of patients admitted to acute general medicine wards in an Australian tertiary hospital over 5 years was conducted. A SDM programme with a new GoC form, communication training and clinical support was implemented. The primary outcome was the proportion of patients with a documented person‐centred GoC discussion (PCD). Clinical outcomes included hospital utilisation and 90‐day mortality. Results: 1343 patients were included. The proportion of patients with PCDs increased from 0% to 35.4% (adjusted odds ratio (aOR), 2.38; 95% confidence interval (CI), 2.01–2.82; P < 0.001). During this time, median hospital length of stay decreased from 8 days (interquartile range (IQR), 4–14) to 6 days (IQR, 3–11) (adjusted estimate effect, −0.38; 95% CI, −0.64 to −0.11; P = 0.005) and rapid response team activation from 28% to 13% (aOR, 0.87; 95% CI, 0.78–0.97; P value = 0.01). Documented treatment preference of high‐dependency unit care decreased from 39.7% to 24.4% (aOR, 0.81; 95% CI, 0.73–0.89; P value < 0.001), and ward‐based care increased from 31.9% to 55.1% (aOR, 1.24; 95% CI, 1.14–1.36; P value < 0.001). Conclusion: The implementation of a SDM programme was associated with increased documentation of person‐centred GoC, changed patient treatment preference to lower intensity care and reduced hospital utilisation. [ABSTRACT FROM AUTHOR]

Objective: Examine values, preferences and goals elicited by doctors following goals-of-care (GOC) discussions with critically ill patients who had life-limiting illnesses. Design: Descriptive qualitative study using four-stage latent content analysis. Setting: Tertiary intensive care unit (ICU) in South Western Victoria. Participants: Adults who had life-limiting illnesses and were admitted to the ICU with documented GOC, between October 2016 and July 2018. Intervention: The iValidate program, a shared decision-making clinical communication education and clinical support program, for all ICU registrars in August 2015. Main outcome measures: Matrix of themes and subthemes categorised into values, preferences and goals. Results: A total of 354 GOC forms were analysed from 218 patients who had life-limiting illnesses and were admitted to the ICU. In the categories of values, preferences and goals, four themes were identified: connectedness and relational autonomy, autonomy of decision maker, balancing quality and quantity of life, and physical comfort. The subthemes - relationships, sense of place, enjoyment of activities, independence, dignity, cognitive function, quality of life, longevity and physical comfort - provided a matrix of issues identified as important to patients. Relationship, place, independence and physical comfort statements were most frequently identified; longevity was least frequently identified. Conclusion: Our analysis of GOC discussions between medical staff and patients who had life-limiting illnesses and were admitted to the ICU, using a shared decision-making training and support program, revealed a framework of values, preferences and goals that could provide a structure to assist clinicians to engage in shared decision making., Competing Interests: None declared., (© 2021 College of Intensive Care Medicine of Australia and New Zealand.)