Seriously Ill Patients' Prioritized Goals and Their Clinicians' Perceptions of Those Goals

Matthew E Modes; Ruth A Engelberg; Elizabeth L Nielsen; Lyndia C Brumback; Thanh H Neville; Anne M Walling; J Randall Curtis; Erin K Kross

doi:10.1016/j.jpainsymman.2022.06.004

Seriously Ill Patients' Prioritized Goals and Their Clinicians' Perceptions of Those Goals

J Pain Symptom Manage. 2022 Oct;64(4):410-418. doi: 10.1016/j.jpainsymman.2022.06.004. Epub 2022 Jun 11.

Authors

Matthew E Modes¹, Ruth A Engelberg², Elizabeth L Nielsen², Lyndia C Brumback³, Thanh H Neville⁴, Anne M Walling⁵, J Randall Curtis⁶, Erin K Kross²

Affiliations

¹ Division of Pulmonary and Critical Care Medicine (M.E.M), Cedars-Sinai Medical Center, Los Angeles, California, USA. Electronic address: matthew.modes@cshs.org.
² Division of Pulmonary (R.A.E., E.L.N., J.R.C., E.K.K.), Critical Care and Sleep Medicine, University of Washington, Seattle, Washington, USA; Cambia Palliative Care Center of Excellence (R.A.E., E.L.N., L.C.B., J.R.C., E.K.K.), University of Washington, Seattle, Washington, USA.
³ Cambia Palliative Care Center of Excellence (R.A.E., E.L.N., L.C.B., J.R.C., E.K.K.), University of Washington, Seattle, Washington, USA; Department of Biostatistics (L.C.B.), University of Washington, Seattle, Washington, USA.
⁴ Division of Pulmonary (T.H.N.), Critical Care, and Sleep Medicine, University of California Los Angeles, Los Angeles, California, USA.
⁵ Division of General Internal Medicine and Health Services Research (A.M.W.), University of California Los Angeles, Los Angeles, California, USA; Center for the Study of Healthcare Innovation (A.M.W.), Implementation and Policy, Veterans Affairs Greater Los Angeles Health Care System, Los Angeles, California, USA.
⁶ Division of Pulmonary (R.A.E., E.L.N., J.R.C., E.K.K.), Critical Care and Sleep Medicine, University of Washington, Seattle, Washington, USA; Cambia Palliative Care Center of Excellence (R.A.E., E.L.N., L.C.B., J.R.C., E.K.K.), University of Washington, Seattle, Washington, USA; Department of Bioethics and Humanities (J.R.C.), University of Washington, Seattle, Washington, USA.

Abstract

Context: Seriously ill patients whose prioritized healthcare goals are understood by their clinicians are likely better positioned to receive goal-concordant care.

Objectives: To examine the proportion of seriously ill patients whose prioritized healthcare goal is accurately perceived by their clinician and identify factors associated with accurate perception.

Methods: Secondary analysis of a multicenter cluster-randomized trial of outpatients with serious illness and their clinicians. Approximately two weeks after a clinic visit, patients reported their current prioritized healthcare goal- extending life over relief of pain and discomfort, or relief of pain and discomfort over extending life - and clinicians reported their perception of their patients' current prioritized healthcare goal; matching these items defined accurate perception.

Results: Of 252 patients with a prioritized healthcare goal, 60% had their goal accurately perceived by their clinician, 27% were cared for by clinicians who perceived prioritization of the alternative goal, and 13% had their clinician answer unsure. Patients who were older (OR 1.03 per year; 95%CI 1.01, 1.05), had stable goals (OR 2.52; 95%CI 1.26, 5.05), and had a recent goals-of-care discussion (OR 1.78, 95%CI 1.00, 3.16) were more likely to have their goals accurately perceived.

Conclusion: A majority of seriously ill outpatients are cared for by clinicians who accurately perceive their patients' prioritized healthcare goals. However, a substantial portion are not and may be at higher risk for goal-discordant care. Interventions that facilitate goals-of-care discussions may help align care with goals, as recent discussions were associated with accurate perceptions of patients' prioritized goals.

Keywords: Advance care planning (ACP); Clinician identification; Clinician perception; Clinician understanding; End-of-life; Goal-concordant care; Goals; Goals-of-care; Palliative care; Preferences; Serious illness; Values.

Publication types

Multicenter Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Advance Care Planning*
Communication
Goals*
Humans
Pain

Abstract

Publication types

MeSH terms

Grants and funding