{"entity":{"id":"idea-moon-goals-conversation-trigger","kind":"idea","name":"Algorithm-triggered goals-of-care conversations before crisis","aka":[],"tldr":"When a prediction model says a patient has a high chance of dying within a year, their team is prompted to have a structured conversation about what matters to them, while there is still time to act on it.","summary":"Most patients with advanced cancer do not have documented conversations about goals until the final weeks. A randomised trial at Penn used a machine-learning mortality prediction to nudge oncologists, quadrupling serious illness conversations. The proposal is to make this standard: validated risk model, default prompt with a Serious Illness Conversation Guide, documentation template, and measurement of goal-concordant care and end-of-life chemotherapy use.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Patients lack understanding, navigation and agency): Basch et al., Overall survival results of a trial assessing patient-reported outcomes for symptom monitoring during routine cancer treatment (JAMA 2017)","url":"https://doi.org/10.1001/jama.2017.7156"}],"tags":[],"related":[],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":["penn-abramson"],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-patient-voice","b-palliative"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Triggered conversations increase documented goals within 3 months of a high-risk flag from under 20% to over 50%, reduce systemic therapy in the last 14 days of life, and improve family-reported quality of dying.","rationale":"Clinicians overestimate prognosis and avoid the conversation; a neutral prompt gives permission and a time. The behaviour change has been demonstrated; the outcomes now need scale.","test":"Multi-centre stepped-wedge implementation with end-of-life quality metrics and bereaved-family surveys as primary outcomes.","maturity":"being-tested-at-scale","actor":"clinic","cost":"small","horizonYears":2},"route":"/ideas/idea-moon-goals-conversation-trigger/","neighbours":{"institution":[{"id":"penn-abramson","kind":"institution","name":"Abramson Cancer Center, University of Pennsylvania","route":"/institutions/penn-abramson/"}],"bottleneck":[{"id":"b-palliative","kind":"bottleneck","name":"Pain relief and palliative care are unavailable to most","route":"/bottlenecks/b-palliative/"},{"id":"b-patient-voice","kind":"bottleneck","name":"Patients lack understanding, navigation and agency","route":"/bottlenecks/b-patient-voice/"}]}}