Effect of a person-centred goals-of-care form and clinical communication training on shared decision-making and outcomes in an acute hospital: a prospective longitudinal interventional study

Andrew P Tierney; Sharyn Milnes; Anita Phillips; Nicholas Simpson; Michael Bailey; Charlie Corke; Neil R Orford

doi:10.1111/imj.16381

Effect of a person-centred goals-of-care form and clinical communication training on shared decision-making and outcomes in an acute hospital: a prospective longitudinal interventional study

Intern Med J. 2024 Mar 23. doi: 10.1111/imj.16381. Online ahead of print.

Authors

Andrew P Tierney¹, Sharyn Milnes^{1

2}, Anita Phillips^{1

2}, Nicholas Simpson^{1

2}, Michael Bailey³, Charlie Corke^{1

2}, Neil R Orford^{1

2

3

4}

Affiliations

¹ Intensive Care Department, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia.
² School of Medicine, Deakin University, Geelong, Victoria, Australia.
³ Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventative Medicine (SPHPM), Monash University, Melbourne, Victoria, Australia.
⁴ Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia.

PMID: 38520171
DOI: 10.1111/imj.16381

Abstract

Background: Patients with a life-limiting illness (LLI) requiring hospitalisation have a high likelihood of deterioration and 12-month mortality. To avoid non-aligned care, we need to understand our patients' goals and values.

Aim: To describe the association between the implementation of a shared decision-making (SDM) programme and documentation of goals of care (GoC) for hospitalised patients with LLI.

Methods: A prospective longitudinal interventional study of patients admitted to acute general medicine wards in an Australian tertiary hospital over 5 years was conducted. A SDM programme with a new GoC form, communication training and clinical support was implemented. The primary outcome was the proportion of patients with a documented person-centred GoC discussion (PCD). Clinical outcomes included hospital utilisation and 90-day mortality.

Results: 1343 patients were included. The proportion of patients with PCDs increased from 0% to 35.4% (adjusted odds ratio (aOR), 2.38; 95% confidence interval (CI), 2.01-2.82; P < 0.001). During this time, median hospital length of stay decreased from 8 days (interquartile range (IQR), 4-14) to 6 days (IQR, 3-11) (adjusted estimate effect, -0.38; 95% CI, -0.64 to -0.11; P = 0.005) and rapid response team activation from 28% to 13% (aOR, 0.87; 95% CI, 0.78-0.97; P value = 0.01). Documented treatment preference of high-dependency unit care decreased from 39.7% to 24.4% (aOR, 0.81; 95% CI, 0.73-0.89; P value < 0.001), and ward-based care increased from 31.9% to 55.1% (aOR, 1.24; 95% CI, 1.14-1.36; P value < 0.001).

Conclusion: The implementation of a SDM programme was associated with increased documentation of person-centred GoC, changed patient treatment preference to lower intensity care and reduced hospital utilisation.

Keywords: advanced care planning; communication; end‐of‐life; person‐centred care; shared decision‐making.