Shared decision-making about goals of care at end of life: What does implementation research have to offer?, Washington University in St. Louis

People increasingly seek to shape the goals of their care at the end of life. Goals of Care interventions (living wills, advance care directives, treatment escalation plans, complex shared decision-making tools) have focused on ensuring dignity and comfort at times when it is impossible for people to articulate their preferences and influence the conduct of their care because of physical or mental incapacity. These interventions also call for the design and implementation of institutional processes through which preferences can be recorded, negotiated into practice, and then enacted on the person’s behalf. This is often a real challenge.

In this seminar, Carl May of the London School of Hygiene & Tropical Medicine will set out a robust and empirically validated model of implementation processes (normalization process theory); links this to a series of studies that have considered problems of implementing goals of care interventions; and explores how institutional contexts, implementation mechanisms, and intervention outcomes interact with each other in ways that are generative of change.

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