Traditionally, goals-of-care conversations are reserved for end-of-life care, but The University of Texas MD Anderson Cancer Center is changing that.
MD Anderson launched the Center for Goal Concordant Care in 2020. It has one overarching goal, “to ensure we have early and empathetic goals-of-care conversations with our patients,” Nico Nortjé, PhD, executive director of the center for clinical ethics in cancer care and director of goal concordant care and end-of-life at the Houston-based system, told Becker’s. “Essentially, we make sure we list the patient’s values and preferences on one hand, while the physicians share what is clinically possible on the other. Together, we forge a care plan from there.”
MD Anderson is changing its culture so these goal conversations occur by at least the third patient visit. These conversations aren’t necessarily about end of life, but more about functionality, context and expectations. Clinicians are encouraged to keep having these discussions over the course of treatment to ensure patients are provided care that aligns with their values.
“This initiative is not just physician-driven — it’s institutionwide,” Dr. Nortjé said. “Our bedside nurses participate. Our case managers, social workers, chaplains, physicians, advanced practice providers, everyone who has clinical touchpoints with patients. We teach them how to have these discussions, we guide them through roleplays, and then we create the spaces for them to actually do it.”
Buttressing MD Anderson’s Center approach to these conversations is its research team, headed by David Hui, MD. Dr. Hui is director and head Center for Goal Concordant Care Research and professor of palliative care, rehab and integrated medicine. He studies the impact of Dr. Nortje’s team and identifies areas for improvement.
“There are many unanswered questions in this field,” Dr. Hui said. “Our mission is to drive forward the development of solutions that can be brought back to the bedside to continually improve patient care.”
His research team has published multiple studies on the impacts of multi-component goals-of-care program. Here are some of the results:
- ICU mortality reduced by 6.3%.
- Length of stay cut by 1.6 days among patients admitted to an ICU.
- The cost of care dropped by 17% among patients admitted to an ICU.
- Overall hospital mortality also declined 0.9% and 30-day readmission rates saw a 1.8% reduction.
“We measure outcomes like lower length of stay and cost savings, but the real wins are these moments where we’ve made a positive, generational impact on a family’s life,” Dr. Nortjé said. “If we focus on treating patients as full human beings, we’ll find benefits that go far beyond financial metrics.”
And there have been other surprising impacts of the center. One is reducing clinician burnout and stress.
“When clinicians are equipped with the tools to navigate complex, stressful situations — and can see the benefits and positive impact on patients — they feel more prepared and less burdened,” Dr. Hui said. “Clinicians reflect on those difficult experiences and how using communication skills helps them find meaning in the conversations.”
How you can start tomorrow
MD Anderson’s program has been running for years, but there are a few things every leader could start tomorrow to bring something similar to their system, according to Dr. Nortjé.
“Take the village approach,” Dr. Nortjé said. “This work cannot be owned by a single department like palliative care or the APPs. Everyone needs to be involved — it truly takes a village.”
Dr. Hui said gathering that data is the first vital step to identifying gaps, needs and measuring success. His team did pre-studies to determine what areas clinicians needed help with, and they found clinician confidence in their communication skills were low.
“It’s not that they didn’t have the skills — they just didn’t believe they had them,” Dr. Nortjé said. “Once you give people a basic framework, they realize, ‘Wait, I’m already doing a lot of this.’ It boosts their confidence. Providing a simple, structured framework — something as basic as five steps — is an easy lift. And you don’t need to spend millions of dollars to implement it.”