Background A key outcome of successful advance care planning is consistency between patient goals of care and the care provided. However, assessing consistency is methodologically challenging due to conceptual and logistical barriers as well as practice limitations.

Methods The team reviewed the literature and identified key methodological barriers to measuring care consistency with patient preferences and goals of care. Strategies to overcome these barriers are proposed.

Results Key methodological barriers include: 1) the specificity and relevance of documentation about preferences and goals of care; 2) the availability of documentation about preferences and goals of care; 3) the stability of documented preferences and goals of care; 4) the timing of treatments provided and identifying decisions not to treat (“non- events”); and 5) calculating rates of consistency. Strategies to address these methodological barriers include using tools to document specific preferences, incorporation into electronic health records, period reassessment of preferences, prospective data collection, and using percent agreement to report consistency.

Discussion There are clear challenges to assessing care consistency with preferences and goals of care. The ability to assess and report on this important outcome of successful advance care planning requires focused efforts to improve practice.