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System Wide Goals of Care Implementation: A Podcast with Ira Byock, Chris Dale, and Matt Gonzales

GeriPal - A Geriatrics and Palliative Medicine Podcast

Release Date: 07/24/2025

What Makes a Good Death?  Karen Steinhauser, Rasa Mikelyte, Edison Vidal show art What Makes a Good Death? Karen Steinhauser, Rasa Mikelyte, Edison Vidal

GeriPal - A Geriatrics and Palliative Medicine Podcast

What is a “good death”? How should we define it, and who gets to decide? Is the concept of a “good death” even useful? Twenty-five years ago, Karen Steinhauser published a groundbreaking study in JAMA that transformed my understanding of what it means to have a good death and questioned the usefulness of the term itself. This study examined the factors that are important at the end of life for patients, families, physicians, and other healthcare providers. In today’s podcast, we are honored to have Karen join us to discuss this pivotal study and the nature of a “good death”. We...

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GeriPal - A Geriatrics and Palliative Medicine Podcast

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GeriPal - A Geriatrics and Palliative Medicine Podcast

On today’s podcast, we talk about an innovative specialized primary care model for older veterans called the Geriatric Patient Aligned Care Team (GeriPACT) program.  It’s designed with smaller patient panels and enhanced social worker and pharmacist involvement, and its approach is aimed at improving care and outcomes for our aging population. We unpack the intriguing findings of a recent , looking at GeriPACT that compares it to a traditional Patient Aligned Care Team (PACT).  While GeriPACT successfully delivered more attention to geriatric conditions, it surprisingly didn't...

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GeriPal - A Geriatrics and Palliative Medicine Podcast

With all the attention focused on Alzheimer's biomarkers and amyloid antibodies, it’s easy to forget that comprehensive dementia care is more than blood draws and infusions. On today’s podcast, we buck this trend and dive into the complexities and challenges of comprehensive dementia care with the authors of two pivotal articles recently published in JAMA. We’ve invited David Reuben and Greg Sachs to talk about their two respective trials, published in JAMA — and — aimed at improving the evidence for care models supporting individuals diagnosed with dementia. D-CARE tested the...

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GeriPal - A Geriatrics and Palliative Medicine Podcast

In today’s podcast we talk with Eric Wong, geriatrician-researcher from Toronto, and Thiago Silva, geriatrician-researcher from Brazil, about the comprehensive geriatrics assessment.  We spend the first 30 minutes (at least) discussing what, exactly is the comprehensive geriatric assessment, including: What domains of assessment are essential/mandatory components of the comprehensive geriatrics assessment? Who performs it? Is a multidisciplinary team required? Can a geriatrician perform it alone? Can non-geriatricians perform it? Who is the comprehensive geriatrics assessment for?...

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GeriPal - A Geriatrics and Palliative Medicine Podcast

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GeriPal - A Geriatrics and Palliative Medicine Podcast

Health care trainees rotate through a variety of different settings. ICUs, hospital wards, and outpatient clinics. If they're lucky, they might even spend time in a nursing home. But on today’s podcast, we’re adding one more setting to that list: your local art museum. In this thought-provoking episode, we explore how art museum teaching is being integrated into the education of medical professionals—and why it's making a profound difference. Our guests, , , and , share their journey of integrating art into medical training, along with practical strategies you can use if you're inspired...

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GeriPal - A Geriatrics and Palliative Medicine Podcast

In his book, “,” Victor Montori decries the industrialization of healthcare.  We’ve become a healthcare factory, beholden to health systems motivated by profit. In particular, he laments the loss of the “care” aspect of healthcare. Clinicians are under the clock to churn through patients.  Patients are tasked with doing work outside of the clinic. Patients are tasked with hours and hours of work to self manage, obtain and manage medications, track weights and fingersticks, not to mention scheduling visits and waiting around for the visit to start. Now we have an app for...

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System Wide Goals of Care Implementation: A Podcast with Ira Byock, Chris Dale, and Matt Gonzales show art System Wide Goals of Care Implementation: A Podcast with Ira Byock, Chris Dale, and Matt Gonzales

GeriPal - A Geriatrics and Palliative Medicine Podcast

Most health care providers understand the importance of goals-of-care conversations in aligning treatment plans with patients’ goals, especially for those with serious medical problems. And yet, these discussions often either don't happen or at least don't get documented. How can we do better? In today’s podcast, we sit down with Ira Byock, Chris Dale, and Matthew Gonzales to discuss a multi-year healthcare system-wide goals of care implementation project within the Providence Health Care System. Spanning 51 hospitals, this initiative was recently described in NEJM Catalyst, showing truly...

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GeriPal - A Geriatrics and Palliative Medicine Podcast

What is death anxiety?  We spend the first 15 minutes of the podcast addressing this question.  And maybe this was unfair to our guests, the fabulous dynamic duo of palliative psychiatrists Dani Chammas and Keri Brenner (listen to their prior podcasts on and the ).  After all, we invited them on to our podcast to discuss death anxiety, then Eric and I immediately questioned if death anxiety was the best term for what we want to discuss! Several key points stood out to me from this podcast, your key points may differ: The “anxiety” in “death anxiety” is not a...

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More Episodes

Most health care providers understand the importance of goals-of-care conversations in aligning treatment plans with patients’ goals, especially for those with serious medical problems. And yet, these discussions often either don't happen or at least don't get documented. How can we do better?

In today’s podcast, we sit down with Ira Byock, Chris Dale, and Matthew Gonzales to discuss a multi-year healthcare system-wide goals of care implementation project within the Providence Health Care System. Spanning 51 hospitals, this initiative was recently described in NEJM Catalyst, showing truly impressive results, including an increase from 7% to 85% in goals of care conversation documentation for patients who were in an ICU for 5 or more days.

How did they achieve this?  Our guests will share insights into the project’s inception and the strategies that drove its success, including:

  1. Organizational Alignment: Integrating GOC documentation into the health system’s mission, vision, and strategic objectives.

  2. Clinical Leadership Partnership: Collaborating with clinical leaders to establish robust quality standards and metrics.

  3. Ease of Documentation: Upgrading the electronic health record (EHR) system to streamline the documentation and retrieval of GOC conversations.

  4. Communication Training: Conducting workshops based on the Serious Illness Conversation Guide to equip clinicians with the skills needed for impactful GOC conversations.

Join us as we explore how these strategies were implemented and learn how you can apply similar approaches in your own healthcare setting.