Background: Early goals of care (GOC) conversations show improved patient outcomes and reduced health care costs. However, content and consistency of these discussions are been variable. 

Methods: We aimed to assess baseline quantity and quality of GOC directives and discussions documentation in 30 randomly selected patients from CKD and dialysis clinics across 5 health authorities in BC to inform future quality improvement initiatives.

Outcomes: GOC directives were frequently documented (80%). GOC discussions were much less commonly documented (47%); there was wide variability across health authorities (0-100%). Documentation regarding GOC was sparse in PROMIS (23%). While prognosis and patients’ level of understanding was frequently documented during GOC discussions (92.3% & 69%), patients’ goals and involvement of family was less frequent (53% & 46%).
 
Conclusion:  Our pre-implementation baseline assessment informs that there is room for improvement in the quantity of GOC discussions as well as consistency in documentation across health authorities and in PROMIS.

Evaluation of provincial initiatives in palliative care: a baseline assessment of pre-implementation clinician practices