A New Path to Patient-Centered Decision-Making for Older Adults in the Hospital

Valerie Louis

Older adults in hospitals are often not asked about their goals of care until a medical emergency forces the issue. Without documented preferences, full resuscitation becomes the default regardless of whether it reflects the patient’s wishes or serves their best interest.

Valerie Louis, a medical student at the Northern Ontario School of Medicine University, is working to address this gap in care with the AKmeGOC study, preliminary findings from which she presented at the 2025 American College of Physicians (ACP) Internal Medicine Meeting in New Orleans. HCPLive spoke with Louis to learn more about how she and her team developed an electronic tool to help elderly patients preemptively record their care preferences.

HCPLive: What motivated the ASKmeGOC study and what gaps in care is it addressing?

Valerie Louis: I'm here at ACP this weekend presenting a research project that I've been working on for the past year and a half or so, called the Ask Me Goals of Care (ASKmeGOC) Study, which is essentially an electronic tool that we developed to help elderly patients make decisions surrounding life-sustaining treatments and resuscitation preferences while they're in the hospital.

Unfortunately, a lot of elderly patients come into the hospital and then nobody asks them about the care that they would or would not accept in the event of health deterioration. So, what ends up happening is, in the event where something does happen while the patient is in the hospital, if there's nothing documented, then the burden of decision-making falls on the family members and the healthcare team. The default is to provide all resuscitative life-supporting measures if there is nothing else indicated by the patient—and that's not necessarily always what the patient would want or what's in their best interest.

So, our goal with the study was to rewind and have these conversations with patients when they're relatively well in the hospital—they're not in intensive care, they're not on any life-sustaining treatments—and have that conversation with them about, hypothetically, should something happen, what they would or would not accept. And really incorporate that education piece of: What is intubation? What is cardiac arrest? What are chest compressions? What are the different types of measures that we can provide for patients in the ICU? And whether or not they would accept different things.

So that way, they have a documented preference in their chart. And our goal with the study was to see if, ultimately, it ends up reducing ICU utilization, and if patients are feeling more sure, satisfied, and informed about the decisions they're making about the types of care they would get or not.

Can you outline the ASKmeGOC study and the electronic tool you developed to help document preferences?

Louis: So, it's an electronic tool that's split into 4 different modules. The first one looks at the patient's current health status—what their functionality is like, mobility, independence, activities of daily living, that sort of thing. Then it looks at the reason for hospitalization. So it takes into account age, comorbidities, the reason for hospitalization, how long they've been in the hospital, and it provides them with accurate statistical prognosis of the probability of discharge for the reason they're hospitalized.

Then the next step goes into the hypotheticals—so, a hypothetical case of acute health deterioration or cardiac arrest—and what the statistics and prognosis are given all the information that they had input in the previous module. Then it goes into a kind of sliding visual analog scale of what the patient wants: Would they want to be kept alive at all costs, or would they want complete palliative comfort measures, and everything in between? Clicking on different things explains each step.

We used ICU nurses—those were the ones using this app and having these conversations with patients. Every patient 80 and up that came into our hospital at the Royal Victoria Regional Health Centre in Barrie, Ontario, between October 2023 and October 2024, would get randomized to either get our conversation or not. Then maybe they'd have one with their primary physician or whoever their in-hospital provider is. We would follow up with them as the research team—if a conversation occurred, how satisfied they feel about their decisions, and any feedback they have about how the conversation was conducted.

So that's essentially what we did for about a year. We enrolled about 1,100 patients into the study. It ended up being the largest randomized control trial in a community hospital in Canada, which was a really big deal for us. It was very exciting. That gives you a little bit of background.

Patients would walk through this tool on an iPad with the help of an ICU nurse. The conversations would take about a half hour each, and then ultimately, the patients would make a decision about what they would or would not want. Then we'd put it in the chart, and they had something there.

What did you find in the ASKmeGOC study?

Louis: We found a few different things that were really interesting. We found a significant decrease in the number of ICU days and the number of ventilator days. Those were the 2 big ones. We looked at ICU days in general, ventilator days, and dialysis days. The number of patients with nothing documented in their chart went from 25% to 4% in our intervention group. So, you have that huge chunk of patients who never got a conversation—who did, which was something really big for us.

The number of ICU days dropped by 30% for patients who got our conversation, and the number of ventilator days dropped by 60% in patients that had our conversation. That shows that, given more information and time to make decisions—and time to consult with family and friends outside of a moment of crisis—there was a reduction in the types of life-sustaining treatments elderly patients would choose.

These are patients above the age of 80 in the hospital. So obviously, looking at their health status before they came in—and unfortunately, a lot of the time, if they go into cardiac arrest and recover, their functionality and quality of life might not be what it was before. So it’s taking all these things into account.

There were also significant differences in how sure they felt about their decisions and whether they felt informed about the benefits and harms of treatment options. So those were other things we looked at, which was great.

Ultimately, this could also result in decreased expenditures by the hospital. If fewer patients are going into the ICU for care they don’t want or need, you’re saving those funds and resources. You’re increasing ICU capacity for patients who truly need it. You're reducing the burden on both healthcare providers and families, who no longer have to make difficult decisions for the patient, which is a huge burden itself. And patients are spending less time in the ICU, so the burden on themselves and their suffering is also reduced—they’re not being intubated unnecessarily.

We’re also tracking data and results up to 12 months post-discharge. So, we tracked utilization in the hospital, and we’re following them up for a year after. That will wrap up around October 2025. Then we’ll be able to get our final results and see—does having the conversation once carry over for a year, or do we see a drop in efficacy?

Is there further research that you want to do around improving decision-making post-discharge? And would you like to expand the use of this tool?

Louis: So, for the purposes of our study, we restricted it to patients 80 and up. But right now, we're scaling up—at our hospital and at a bunch of others in Ontario and across Canada. We’re also partnered with Sharp Medical in San Diego since they had something similar going on. So, we’re trying to expand internationally and maybe get this app to become a standard of care or be used more often.

Our biggest goal is letting patients have autonomy in decision-making. It’s their care—they should be making the decisions. And we want to reduce low-value care—care that isn’t beneficial for them. So those are the two big things we’re working on. We're also working to expand the tool to primary care offices and long-term care homes.

This content has been edited for clarity.

REFERENCE

Louis V. Assessment of Shared Decision-making Tool for Eliciting Informed Goals of Care in the Hospitalized Elderly: A Randomized Trial (ASKmeGOC Study). Presented at: ACP IM Meeting 2025; April 3-5; New Orleans, Louisiana.