NJ Goals of Care works to strengthen communication between health care providers and patients nearing the end of life in order to eliminate burdensome care, improve quality of life, and ensure that treatment decisions focus on patients’ goals.
Who We Are
Goals of Care (GOC) is a 501(c)(3) nonprofit with strong roots to New Jersey and a deep commitment to improving care for New Jersey seniors. Our medical director and founder, David Barile, MD, is a board-certified physician in Internal Medicine, Geriatric Medicine, and Hospice and Palliative Medicine. He also serves as the Medical Director of the Acute Care for the Elderly Unit at Princeton HealthCare System.
Dialogue that is genuinely patient-centered places demands on both sides of the conversation. Patients and surrogate decision-makers must fully understand the medical conditions, prognoses, and treatment options; health care providers must be able to communicate prognoses in a culturally sensitive and health-literate manner and help patients articulate their personal goals. Our key objective is to give health care providers and their patients the tools and training
- to structure these difficult conversations,
- to help patients make informed decisions,
- and to keep the patient’s goals of care at the center of the dialogue.
To meet this objective, Goals of Care has developed a Four-Step Model © in which conversations between the medical team and the patient’s decision-makers are structured around the following questions:
- What is the Diagnosis?
- What is the Prognosis?
- What are the patient’s Goals of Care in the context of this Prognosis?
- What Treatment options will achieve these goals?
Doctors are well-trained in the traditional two-step model of confirming the diagnosis (step one) and prescribing treatment (step two), but the two-step model lacks the key elements of communicating the prognosis and eliciting the patient’s goals in light of that prognosis. Our Four-Step Model is a unique tool that gives both sides of the conversation structure and responsibility. Goals of Care is at work on a number of initiatives to make this new Four-Step Model an integral part of medical training and practice.
Additionally, Goals of Care has played a vital role in the design and implementation of the New Jersey POLST form (Practitioner Orders for Life Sustaining Treatment), which has become a key tool for improving doctor-patient communication and ensuring that treatment decisions stay focused on the patient’s goals.
Our strategic goals may be summarized as follows:
- To communicate the Four-Step Model through medical webinars, physician training, and collaborative efforts with hospitals and other organizations involved in patient-care.
- To assess the effectiveness of the Four-Step Model through pilot programs that measure medical outcomes, length of stay, and cost savings.
- To promote appropriate use of the NJ POLST form.
- To develop on-line tools that facilitate use of the Four-Step Model and the NJ POLST form by health care professionals and their patients and families.
To meet our strategic goals and fulfill our mission, we are currently engaged in the following projects:
- Through a grant award from Horizon Foundation, GOC has created a series of four webinars that are being presented, starting in September 2015, to internal medicine residents and other healthcare professionals at most teaching hospitals in New Jersey. This program is unique in that it includes the whole medical team and provides CME and CE credits for doctors, nurses, and social workers. The effectiveness of this educational program will be assessed through follow-up surveys of attendees and participating institutions.
- In collaboration with Bridgeway Senior Healthcare, Care Associates Network and Health Care Association of New Jersey, GOC has created a series of educational videos about the NEW JERSEY POLST form. The aim is to encourage use of the NJ POLST form in order to reduce unwanted transfers and more fully align treatment with patients’ goals of care.
- On our website, we offer “The GOC Learning Center,” which comprises a series of brief educational videos for patients and surrogate decision makers. These “Learn More About…” videos explain the use of the NJ POLST form and even help viewers prepare a letter to their doctors requesting a conversation about the NJ POLST form. Additionally, decision-makers may learn about the Four-Step Model © approach to help navigate through difficult medical decisions.
- GOC actively promotes the Four-Step Model and the NJ POLST form through its website and through public-speaking engagements by GOC Medical Director David Barile.
The following projects are in the research and planning stages:
- To penetrate the curricula of medical education programs throughout New Jersey with the kind of webinar training program being piloted through the Horizon Foundation Grant.
- To expand the POLST education program being piloted at Bridgeway to healthcare facilities throughout New Jersey.
- To create a training program of simulated evaluations using the Four-Step Model to be presented in Grand Rounds at training hospitals throughout New Jersey.
- To develop an educational program on end-of-life care for high school seniors. We see this as a key component of health and wellness curricula at the high school level. We are currently gathering data for this effort through an on-line survey of high school students in central New Jersey.
Founder and Executive Medical Director
Joe Fennelly, MD
The Rev. Robin Bacon Hoffman
Aline Holmes, DNP(c) RN
Robert Pickens, MD
Van Zandt Williams, Jr.
Consultant to New Jersey Goals of Care
Bill Schofield, Schofield Group