Table 3.

The multivalent concept represented by the phrase “goals of care” in the EHR.

Concept	Exemplary Quotes
An expression to indicate poor prognosis	Discussed goals of care with family at bedside; I communicated with family that prognosis is near certain he will not survive
	continue GOC discussions with family given persistent hypotension, persistent encephalopathy
	I spoke with daughters at bedside today - they were asking appropriate questions regarding prognosis and GOC; we discussed from a sepsis standpoint alone his prognosis is extremely poor - prolonged refractory shock with at least 2 organ systems down
A representation of conflict among patients, families, clinicians	looking for family meeting with ethics to try and work toward a more mutual goals of care decision
	will continue to press for further resolution of goals of care
	recommend revisiting GOC (at prior admissions, pt was adamantly full code)
A rationale for limitations on specific treatments	will consider thoracentesis pending GOC
	holding home meds given goals of care
	GOC clarified yesterday: Converted to DNR yesterday, no escalation of care

Abbreviations: GOC = goals of care; DNR = do not resuscitate