Um, so can you, uh, Jackie, give the audience an overview of what we knew about sort of, uh, goal concordance, uh, of care within the ICU, and specifically around mechanical ventilation? What do we know about it prior to your study?

Yeah.

So I think the part about goal concordant care in the ICU that is not complicated, or at least not contested, is that we all generally and pretty widely agree that it's a major goal of the care that we provide in the ICU.

In other words, you know, sort of experts and professional societies, um, all are in favor of this notion that the care we deliver in the ICU to patients with critical illness, and even in the broader context of serious illness in general, um, one of our major goals is that the care we deliver ought to be aligned with what an individual patient's priorities are and what's most important to them.

And so that is one of the key things we know, but it actually gets quite a bit more complicated after that fact and that level of agreement, which is to say that it's been very difficult to operationalize what this means, um, to study it, to measure it.

So even though we understand that this should be one of the things we're, we're trying to achieve in our everyday clinical practice, in our quality and performance improvement efforts, in our research, um, it's been very difficult to measure and, and understand what we mean by goal concordant care.

Um, the challenges here, probably everybody listening to this, um, has some sense of what I'm about to say, but, you know, what we do know is that it-- one reason it's hard to measure goal concordant care in the ICU is that it's a very dynamic clinical environment, and there's a lot of uncertainties.

Do we have any sort of hypotheses why this, uh, may have played out this way?