Practice Guidelines For Care Research Articles

Current Evidence in Palliative Care: A Systematic Review in Support of the National Consensus Project’s Clinical Practice Guidelines for Quality Palliative Care, 4th edition (NCP Guidelines) (SA524)

Current Evidence in Palliative Care: A Systematic Review in Support of the National Consensus Project’s Clinical Practice Guidelines for Quality Palliative Care, 4th edition (NCP Guidelines) (SA524)

Inviting Ourselves to the Party: Cystic Fibrosis as a Model for Implementing Palliative Care Practice, Research, and Policy in "New Diseases” (FR439)

•Describe the opportunities and challenges involved in developing an outpatient palliative care clinic for patients with cystic fibrosis.•Describe a patient-centered model for developing a palliative care intervention in a disease population without much palliative care evidence, as well as the challenges in conducting clinical research in CF palliative care. Cystic fibrosis is a chronic, progressive, and fatal disease. Individuals living with CF suffer from myriad physical and psychosocial burdens that dramatically degrade patient and caregiver quality of life. Although the evidence base for palliative care in CF is scant, patients living with CF and their caregivers undoubtedly possess palliative needs. Yet, no established model of PC exists for this population of high-need patients. Distinctive characteristics of CF, such as its lifelong nature, unpredictable trajectory, advancing therapies that may alter the course of illness dramatically for some, and the complexities of lung transplantation merit evaluation of how PC should be designed for CF. CF is one of many underrepresented disease populations with palliative needs, yet without as strong an evidence base or clinical presence as other classic palliative care populations (e.g., oncology). This multidisciplinary, multi-institutional panel of clinicians and researchers in palliative care, pulmonology, and nursing will highlight opportunities and challenges of “breaking into” new disease populations, using CF as an exemplar. First, we will present a multi-pronged approach of identifying palliative needs in CF using qualitative methods and a nationwide survey, to aid in building support for and developing clinical programs. Second, we will describe the process and lessons learned during the development and conduct of the first clinical trial of palliative care in CF. Third, we will share insights on developing an outpatient CF palliative care clinic. Lastly, we will discuss our experiences with developing practice guidelines for palliative care in populations where need and enthusiasm exist, despite little evidence. Lessons learned in this session will be applicable to other fledgling populations with less established research and clinical presence from palliative care. Through shared learning, this forum will nurture future work to level the playing field so that all patients with life-limiting illness benefit from palliative care, regardless of disease.

Finding Strengths in Our Differences: How Interprofessional Training Prepares Clinicians for Collaborative Practice (SA507)

•Describe the unique aspects of an interprofessional training model from the perspectives of fellowship directors and social work, nurse practitioner, and physician trainees.•Identify the benefits and challenges of an interprofessional training model in providing patient care and promoting self-care.•Devise strategies to develop interprofessional training experiences that attendees can implement in their own palliative care and hospice programs. Clinical practice guidelines for quality palliative care highlight the interprofessional nature of palliative care, recognizing that clinicians in each discipline must understand the unique perspectives and strengths of their colleagues in order to provide comprehensive collaborative care. Despite this, finding clinicians proficient in interprofessional collaborative practice proves difficult due to the lack of interprofessional training programs. Instead, palliative care clinicians often resort to learning to work with team members of different disciplines in the course of delivering complex clinical care to seriously ill patients and their families. One innovative solution to this problem is interprofessional palliative care training programs. Training physicians, nurses, psychosocial clinicians, and other disciplines in an interprofessional fellowship affords professionals insight into the distinct and shared roles of each discipline while allowing trainees dual roles as learner and teacher for their co-fellows. This model includes cross-training experiences, a shared didactic and experiential curriculum, and respectful appreciation of one another’s value. In this concurrent session, attendees will explore this interprofessional educational model through the lens of interprofessional trainees and fellowship directors. Presenters will summarize the literature of interprofessional education, highlight the benefits and challenges of each discipline’s role through case-based clinical scenarios, and examine how this model minimizes compassion fatigue and clinician burnout. Finally, presenters and attendees will explore financial, system, and staff limitations and generate strategies to implement interprofessional training experiences into their own programs. Interprofessional training provides unique benefits to patients, families, trainees, and clinical systems, and should be considered by programs nationwide.

Clinical indicators for common paediatric conditions: Processes, provenance and products of the CareTrack Kids study.

BackgroundIn order to determine the extent to which care delivered to children is appropriate (in line with evidence-based care and/or clinical practice guidelines (CPGs)) in Australia, we developed a set of clinical indicators for 21 common paediatric medical conditions for use across a range of primary, secondary and tertiary healthcare practice facilities.MethodsClinical indicators were extracted from recommendations found through systematic searches of national and international guidelines, and formatted with explicit criteria for inclusion, exclusion, time frame and setting. Experts reviewed the indicators using a multi-round modified Delphi process and collaborative online wiki to develop consensus on what constituted appropriate care.ResultsFrom 121 clinical practice guidelines, 1098 recommendations were used to draft 451 proposed appropriateness indicators. In total, 61 experts (n = 24 internal reviewers, n = 37 external reviewers) reviewed these indicators over 40 weeks. A final set of 234 indicators resulted, from which 597 indicator items were derived suitable for medical record audit. Most indicator items were geared towards capturing information about under-use in healthcare (n = 551, 92%) across emergency department (n = 457, 77%), hospital (n = 450, 75%) and general practice (n = 434, 73%) healthcare facilities, and based on consensus level recommendations (n = 451, 76%). The main reason for rejecting indicators was ‘feasibility’ (likely to be able to be used for determining compliance with ‘appropriate care’ from medical record audit).ConclusionA set of indicators was developed for the appropriateness of care for 21 paediatric conditions. We describe the processes (methods), provenance (origins and evolution of indicators) and products (indicator characteristics) of creating clinical indicators within the context of Australian healthcare settings. Developing consensus on clinical appropriateness indicators using a Delphi approach and collaborative online wiki has methodological utility. The final indicator set can be used by clinicians and organisations to measure and reflect on their own practice.

Clinical Practice Guidelines for Quality Palliative Care.

Clinical Practice Guidelines for Quality Palliative Care.

Key Service Improvements After the Introduction of an Integrated Orthogeriatric Service.

Introduction:Models of orthogeriatric care have been shown to improve functional outcomes for patients after hip fractures and can improve compliance with best practice guidelines for hip fracture care.Methods:We evaluated improvements to key performance indicators in hip fracture care after implementation of a formal orthogeriatric service. Compliance with Irish Hip Fracture standards of care was reviewed, and additional outcomes such as length of stay, access to rehabilitation, and discharge destination were evaluated.Results:Improvements were observed in all of the hip fracture standards of care. Mean length of stay decreased from 19 to 15.5 days (mean difference 3.5 days; P < .05). A higher proportion of patients were admitted to rehabilitation (16.7% vs 7.9%, P < .05), and this happened in a timelier fashion (17.8 vs 24.8 days, P < .05). We found that less patients required convalescence post-hip fracture.Discussion:A standardized approach to integrated post-hip fracture care with orthogeriatrics has improved standards of care for patients.Conclusion:Introduction of orthogeriatric services has resulted in meaningful improvements in clinical outcomes for older people with hip fractures.

175. Implementation of Clinical Practice Guidelines for Care of Neonates With Necrotizing Enterocolitis Reduces Broad Spectrum Antibiotic Use in the Neonatal Intensive Care Unit

BackgroundExposure to broad spectrum antimicrobial agents (AA) is a known risk factor for colonization and infection with multidrug-resistant organisms (MDROs). Therapy with broad spectrum AAs is commonplace with no published guideline to help minimize their use in the NICU. We aimed to analyze clinical indications for the use of vancomycin and meropenem (V/M) in the NICU and the impact of a necrotizing enterocolitis (NEC) clinical practice guideline (CPG) on the use of V/M in the NICU.MethodsPatients who received V/M between January 2015 and December 2015 were identified using pharmacy administration data. Medical charts were reviewed retrospectively by two ID physicians to determine whether V/M were clinically indicated for each definitive course. A CPG outlining the optimal use of AAs for NEC was implemented in the NICU in our institution in August 2015 (Figure 1). We analyzed V/M DOT per 1,000 patient-days before and after CPG implementation. There were no parallel changes in antimicrobial stewardship interventions.ResultsAt the start of V/M, mean gestation and chronologic age of the study population were 28.8 weeks and 26.9 days, respectively, and the mean weight was 2,676 g. During the study period, 91 patients received 191 courses of vancomycin and 27 patients received 32 courses of meropenem; ~40% of V/M definitive use did not have a clear clinical indication (Table 1). Thirty-three percent of meropenem definitive use was in infants with NEC. During a 7-month baseline period, mean vancomycin and meropenem use was 105 and 56 DOTs per 1,000 patient-days, respectively. Following NEC CPG implementation, mean vancomycin and meropenem use was 101 and 12 DOTs per 1,000 patient-days, respectively (Figures 2 and 3).ConclusionWidespread use of V/M was identified in the NICU. Following the implementation of NEC CPG, there was a decrease in the utilization of meropenem in the NICU. Table 1: Clinical Indication Determination of V/M Definitive Courses (n)Vancomycin (n = 73)Meropenem (n = 15)Clearly indicated (clinical cultures warrant use)18 (25%)4 (27%)Likely indicated (sepsis in the setting of known MDRO colonization)5 (7%)3 (20%)Clearly not indicated (clinical cultures warrant narrowing)30 (41%)6 (40%)Unclear if indicated (critically ill infant but no known MDRO colonization and negative culture data)20 (27%)2 (13%) Disclosures All authors: No reported disclosures.

Appraising the quality standard underpinning international clinical practice guidelines for the selection and care of vascular access devices: a systematic review of reviews

ObjectiveCatheter-related bloodstream infections are one of the most important adverse events for patients. Evidence-based practice embraces interventions to prevent and reduce catheter-related bloodstream infections in patients. At present, a growing...

Identifying clinical practice guidelines for the supportive care of children with cancer: A report from the Children's Oncology Group.

Providing evidence-based supportive care for children with cancer has the potential to optimize treatment outcomes and improve quality of life. The Children's Oncology Group (COG) Supportive Care Guidelines Subcommittee conducted a systematic review to identify current supportive care clinical practice guidelines (CPGs) relevant to childhood cancer or pediatric hematopoietic stem cell transplant. Only 22 papers met the 2011 Institute of Medicine criteria to be considered a CPG. The results highlight the paucity of CPGs available to pediatric oncology healthcare professionals and the pressing need to create CPGs using current methodological standards.

National Consensus Project Clinical Practice Guidelines for Quality Palliative Care Guidelines, 4th Edition.

Background: The goal of the 4th edition of the National Consensus Project Clinical Practice Guidelines for Quality Palliative Care (NCP Guidelines) is to improve access to quality palliative care for all people with serious illness regardless of setting, diagnosis, prognosis, or age. Objective: The NCP Guidelines are intended to encourage and guide healthcare organizations and clinicians (including nonpalliative care specialists) across the care continuum to integrate palliative care principles and best practices into their routine assessment and care of all seriously ill patients and their family caregivers. Methods: The NCP Guidelines formalize and delineate evidence-based processes and practices for the provision of safe and reliable high-quality palliative care for adults, children, and families with serious illness in all care settings. Results: This article presents the key domains and guidelines of the 4th edition.

Clinical practice guidelines for surgical antimicrobial prophylaxis: Qualitative appraisals and synthesis of recommendations.

Clinical practice guidelines (CPGs) for preoperative care have been developed for surgical antimicrobial prophylaxis (SAP). The objective of this study was to synthetize recommendations for SAP based on best-evaluated CPGs. A systematic literature search for documents related to SAP, published between January 2011 and December 2016, was conducted on MEDLINE (PubMed), EMBASE, and specific CPG websites. Three reviewers independently assessed the rigour of development and editorial independence of CPGs based on domains 3 and 6 of the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument. CPGs with domain 3 scores of 50% and greater were selected for synthesis of recommendations. Two reviewers independently extracted CPG recommendations from among these documents. A third reviewer performed the synthesis of recommendations. The search retrieved 363 documents, of which 29 CPGs were appraised using AGREE II. Only eight (28%) scored 50% and greater in domain 3. Most CPGs addressed topics related to preoperative care, including SAP. No conflicting recommendations were found, and most recommendations were based on clinical practice. The only recommendation for which there was a difference among CPGs was with respect to the time to initiate the administration of antibiotics (1hour before or close to the time of the surgical incision). Four CPGs provide recommendations that demonstrate concern about inadequate SAP prolongation. Several CPGs for SAP were developed without the desired methodological rigour or transparency. Synthesis of recommendations for best-evaluated CPGs provides a broad approach owing to the complementarity of the recommendations.

Nutrition Assessment, Exposures, and Interventions for Very-Low-Birth-Weight Preterm Infants: An Evidence Analysis Center Scoping Review

Annually, 15 million infants, or approximately 1 of every 10, are born before term, 1 Centers for Disease Control and Prevention. Preterm Birth 2017. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pretermbirth.htm. Accessed September 9, 2017. Google Scholar , 2 World Health Organization. Preterm Birth. http://www.who.int/mediacentre/factsheets/fs363/en/. Accessed September 6, 2017. Google Scholar leading to short- and long-term health consequences such as infection, growth concerns, developmental impairment, and other comorbidities. 3 Institute of Medicine. 2007. Preterm Birth: Causes, Consequences, and Prevention. Washington, DC: The National Academies Press. https://doi.org/10.17226/11622. Accessed May 25, 2017. Google Scholar , 4 Platt M.J. Outcomes in preterm infants. Public Health. 2014; 128: 399-403 Crossref PubMed Scopus (123) Google Scholar Nutrition interventions may address some effects of prematurity. However, current, comprehensive, evidence-based nutrition practice guidelines (EBNPGs) for preterm infants are lacking in the literature. 5 Raiten D.J. Steiber A.L. Carlson S.E. et al. Working group reports: Evaluation of the evidence to support practice guidelines for nutritional care of preterm infants-the Pre-B Project. Am J Clin Nutr. 2016; 103: 648S-678S Crossref PubMed Scopus (24) Google Scholar , 6 Raiten D.J. Steiber A.L. Hand R.K. Executive summary: Evaluation of the evidence to support practice guidelines for nutritional care of preterm infants-the Pre-B Project. Am J Clin Nutr. 2016; 103: 599S-605S Crossref PubMed Scopus (20) Google Scholar Existing guidelines for preterm infants are not based on comprehensive systematic reviews (SRs) and may not represent the current population of preterm infants seen in the neonatal intensive care unit (NICU), which include smaller and less developmentally mature infants. 5 Raiten D.J. Steiber A.L. Carlson S.E. et al. Working group reports: Evaluation of the evidence to support practice guidelines for nutritional care of preterm infants-the Pre-B Project. Am J Clin Nutr. 2016; 103: 648S-678S Crossref PubMed Scopus (24) Google Scholar In addition, treatment options for preterm infants are continually evolving, and current guidelines must address relevant practices in the NICU. L. Moloney is nutrition researcher at the Academy of Nutrition and Dietetics, Chicago, IL. M. Rozga is nutrition researcher at the Academy of Nutrition and Dietetics, Chicago, IL. T. R. Fenton is nutrition research lead, Nutrition Services, Alberta Health Services, and associate professor, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

Anterior restoration longevity among nursing facility residents: a 30-year retrospective study.

To assess factors influencing anterior dental restoration longevity among the institutionalized elderly. Among a sample of Eastern Iowa nursing facility dental patients, one anterior restoration placed from 1985 to 2014 was selected at random from each subject. Kaplan-Meier survival curves were generated, with restoration failures defined as subsequent restorative codes involving the same surface; endodontic procedures; or extractions. Bivariate and multivariable Cox proportional hazards modeling were performed. In multivariable analyses, the 1985 to 1999 cohort (n=496) had longer restoration survival in in females<75 years old versus males<75 years old (P=0.016), males ≥75 years old (P=0.026) and females ≥75 years old (P=0.030); one- versus three-surface restorations (P<0.001); and restorations placed by faculty/residents versus pre-doctoral students (P=0.009). The 2000 to 2014 cohort (n=521) had longer restoration survival in females<75 years old versus males ≥75 years old (P=0.012) and females ≥75 years old (P=0.019); residents who paid out-of-pocket versus those on Medicaid (P=0.019); and composite resin versus glass ionomer cement restorations (P<0.001). Knowing how long restorations last, and what factors affect their longevity, could improve treatment planning, informed consent, and communication with residents and caregivers, and also help inform practice guidelines for restorative care among the institutionalized elderly.

National Consensus Project (NCP) Community-Based Practice Guidelines for Quality Palliative Care (FR401)

•Explain how the NCP Guidelines for Community-based Palliative Care were developed•Describe the specific domains of the NCP Guidelines for Community-based Palliative Care•Identify strategies to apply the NCP Guidelines in community-based palliative care settings In January 2017, the National Coalition for Hospice and Palliative Care received funding from the Gordon and Betty Moore Foundation to develop and disseminate national practice guidelines that formalize and delineate provision of quality community-based palliative care delivery for adults, children, and families living with serious and/or chronic progressive illness to safely and reliably meet their supportive care needs where they live. This session will provide an overview of how the National Consensus Project (NCP) Guidelines for Community-Based Palliative Care were developed, the specific domains of the NCP Guidelines and how to begin to implement the draft NCP Guidelines in community-based palliative care provider settings. Even though the NCP Guidelines are still in process of final revisions and endorsements, this session is one of the first presentations to nationally showcase the NCP Guidelines.

Compliance With Best Practice Guidelines for Neurodevelopmental Supportive Care in South Africa: A Situational Analysis.

Neurodevelopmental supportive care provides preterm infants with evidence-based care to ensure the best possible neurological outcomes. The study aimed to determine the compliance of current nursing care practices with best practice guidelines by means of a situational analysis. The situational analysis was done in 2 cycles in the neonatal intensive care units (n = 25) of a private healthcare provider in South Africa. Structured observations were done in cycle 1 using the Implementation of Neurodevelopmental Supportive Care checklist. Cycle 2 comprised focus group discussions to verify findings from cycle 1. Seventeen conclusion statements were formulated, which were thematically combined to be presented as 9 categories: neonatal intensive care unit design, individualized care, family-centered care, infant positioning, handling techniques, environmental manipulation, pain management, knowledge of infant behavior, and feeding. The conclusion statements identified improvement opportunities in current practice and offer suggestions, which can be used to guide an implementation strategy for best practice guidelines of neurodevelopmental supportive care in the neonatal intensive care units of the private healthcare group in future. Addressing improvement opportunities in all the categories will ensure that all aspects of the guideline requirements are met, resulting in a comprehensive strategy improving practice and patient outcomes.

Cancer Care: Supporting Underserved and Financially Burdened Family Caregivers

Family caregivers who provide care for a loved one with advanced cancer suffer physically and psychologically from the care demands of a family member with high symptom burden and a poor prognosis. Often, family members are also faced with financial burden and suffer financial strain from their loved one's care demands. This article describes an ongoing test of a palliative care intervention to support financially burdened caregivers of family members who have advanced cancer. The intervention is designed to decrease family caregiver burden, increase skills preparedness, improve family caregiver quality of life, decrease psychological distress, and increase family caregiver self-care. This intervention is an individualized intervention customized to a particular caregiver and situation. It combines adult teaching principles, the National Comprehensive Cancer Network (NCCN) Distress Guidelines, the Institute of Medicine (IOM) Report on Cancer Care for the Whole Patient, the National Consensus Project (NCP) Clinical Practice Guidelines for Quality Palliative Care, and the concept of self-care. Initial findings indicate that financially strained family caregivers of family members with advanced cancer can benefit from self-care strategies that are designed to meet specific goals and individual needs when combined with a care plan and subsequent evaluations. However, findings indicate that financially strained caregivers may have limited resources and opportunities to utilize self-care strategies.

Development of Consensus-Based Best Practice Guidelines for Postoperative Care Following Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis.

Delphi process with multiple iterative rounds using a nominal group technique. The aim of this study was to use expert opinion to achieve consensus on various aspects of postoperative care following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). Significant variability exists in postoperative care following PSF for AIS, despite a relatively healthy patient population and continuously improving operative techniques. Current practice appears based either on lesser quality studies or the perpetuation of long-standing protocols. An expert panel composed of 26 pediatric spine surgeons was selected. Using the Delphi process and iterative rounds using a nominal group technique, participants in this panel were presented with a detailed literature review and asked to voice opinion collectively during three rounds of voting (one electronic and two face-to-face). Agreement >80% was considered consensus. Interventions without consensus were discussed and revised, if feasible. Consensus was reached to support 19 best practice guideline (BPG) measures for postoperative care addressing non-ICU admission, perioperative pain control, dietary management, physical therapy, postoperative radiographs, surgical bandage management, and indications for discharge. We present a consensus-based BPG consisting of 19 recommendations for the postoperative management of patients following PSF for AIS. This can serve to reduce variability in practice in this area, help develop hospital specific protocols, and guide future research. 5.

Systemic therapy in the curative treatment of head-and-neck squamous cell cancer: Cancer Care Ontario clinical practice guideline.

The aim of the present work was to make recommendations about the use of systemically administered drugs in combination or in sequence with radiation (rt) or surgery, or both, for cure or organ preservation, or both, in patients with locally advanced nonmetastatic (stages iii-ivb) squamous cell carcinoma of the head and neck (lascchn). The Meta-analysis of Chemotherapy in Head and Neck Cancer (mach-nc) reports have, de facto, guided practice since 2000, and so we searched the literature for systematic reviews published from January 2000 to February 2015 in reference to five research questions. A search was also conducted up to February 2015 for randomized trials (rcts) not included in the meta-analyses. Recommendations were constructed using the Cancer Care Ontario Program in Evidence-Based Care practice guidelines development cycle. In addition to updated mach-nc reports, five additional meta-analyses and thirty rcts were identified. Five recommendations for lascchn treatment were generated based on those data. Concurrent chemoradiation (ccrt) is recommended to maximize the chance of cure in patients less than 71 years of age when rt is used as definitive treatment. The same recommendation also applies to patients with resected lascchn considered to be at high risk for locoregional recurrence. For lascchn patients who are candidates for organ preservation strategies and would otherwise require total laryngectomy, either ccrt or induction chemotherapy, followed by rt or surgery based on tumour response is recommended. The addition of cetuximab to intensified rt (concomitant boost or hyperfractionated schedule) is an alternative to ccrt. Routine use of induction chemotherapy to improve overall survival is not recommended. We were able to use high-level evidence from patients receiving rt as definitive or postoperative treatment to generate recommendations for the use of systemic therapy in the treatment of lascchn. A limitation is a lack of stratification for human papillomavirus-related cancers of the oropharynx. One rct provided evidence for the use of cetuximab as an alternative to chemotherapy in the definitive rt setting. Concurrent chemoradiation provides one strategy for larynx preservation, but the best strategy is unclear. Use of induction chemotherapy does not improve overall survival, and its use should be limited to patients requiring immediate tumour downsizing before local therapy.

Application of Primary Care Guideline for Chronic Low Back Pain in the Emergency Department.

Chronic low back pain (CLBP) is a primary care condition that overflows into the emergency department (ED). No ED-specific practice guideline exists for the management of patients with CLBP in the ED setting. Back pain is a common chief complaint, with cases of CLBP making up to 50% of the patients seen with back pain in an urban, freestanding ED affiliated with a multicampus health system in the Midwest where 25% of patients live below the poverty line and 21.8% do not have primary care. Kolcaba's Theory of Comfort guides the implementation of an evidence-based practice application project. The Guideline for the Evidence-Informed Primary Care Management of Low Back Pain from the National Guideline Clearinghouse is introduced. Interprofessional collaboration for immediate referrals was implemented. The plan-do-study-act model was applied with descriptive analysis of the data. Reflective of established specific aims of the project, there was increased (1) support for the use of evidence-based practice guideline among the ED providers and staff, (2) use of evidence-based practices, (3) connection of patients to community resources, (4) evidence-based education for patients, and (5) overall satisfaction with pain management. The effectiveness of the application of this primary care guideline in the ED opens the way both for region-wide application of the guidelines and for the introduction of other primary care practice guidelines for patients who present to the ED with other chronic conditions.

Patient Self-Defined Goals: Essentials of Person-Centered Care for Serious Illness.

This research, a descriptive qualitative analysis of self-defined serious illness goals, expands the knowledge of what goals are important beyond the physical—making existing disease-specific guidelines more holistic. Integration of goals of care discussions and documentation is standard for quality palliative care but not consistently executed into general and specialty practice. Over 14 months, lay health-care workers (care guides) provided monthly supportive visits for 160 patients with advanced heart failure, cancer, and dementia expected to die in 2 to 3 years. Care guides explored what was most important to patients and documented their self-defined goals on a medical record flow sheet. Using definitions of an expanded set of whole-person domains adapted from the National Consensus Project (NCP) Clinical Practice Guidelines for Quality Palliative Care, 999 goals and their associated plans were deductively coded and examined. Four themes were identified—medical, nonmedical, multiple, and global. Forty percent of goals were coded into the medical domain; 40% were coded to nonmedical domains—social (9%), ethical (7%), family (6%), financial/legal (5%), psychological (5%), housing (3%), legacy/bereavement (3%), spiritual (1%), and end-of-life care (1%). Sixteen percent of the goals were complex and reflected a mix of medical and nonmedical domains, “multiple” goals. The remaining goals (4%) were too global to attribute to an NCP domain. Self-defined serious illness goals express experiences beyond physical health and extend into all aspects of whole person. It is feasible to elicit and record serious illness goals. This approach to goals can support meaningful person-centered care, decision-making, and planning that accords with individual preferences of late life.