| Title: |
Seriously Ill Patients’ Prioritized Goals and Their Clinicians’ Perceptions of Those Goals |
| Authors: |
Modes, Matthew E; Engelberg, Ruth A; Nielsen, Elizabeth L; Brumback, Lyndia C; Neville, Thanh H; Walling, Anne M; Curtis, J Randall; Kross, Erin K |
| Source: |
Journal of Pain and Symptom Management, vol 64, iss 4 |
| Publisher Information: |
eScholarship, University of California |
| Publication Year: |
2022 |
| Collection: |
University of California: eScholarship |
| Subject Terms: |
4203 Health Services and Systems (for-2020); 32 Biomedical and Clinical Sciences (for-2020); 3202 Clinical Sciences (for-2020); 42 Health Sciences (for-2020); Pain Research (rcdc); Clinical Research (rcdc); 3 Good Health and Well Being (sdg); Advance Care Planning (mesh); Communication (mesh); Goals (mesh); Humans (mesh); Pain (mesh); Goal-concordant care; Goals-of-care; Goals; Values; Preferences; Palliative care; Serious illness; End-of-life; Advance care planning (ACP); Clinician understanding; Clinician identification; Clinician perception; 11 Medical and Health Sciences (for); Anesthesiology (science-metrix) |
| Subject Geographic: |
410 - 418 |
| Description: |
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. |
| Document Type: |
article in journal/newspaper |
| File Description: |
application/pdf |
| Language: |
unknown |
| Relation: |
qt9qz8s2df; https://escholarship.org/uc/item/9qz8s2df; https://escholarship.org/content/qt9qz8s2df/qt9qz8s2df.pdf |
| DOI: |
10.1016/j.jpainsymman.2022.06.004 |
| Availability: |
https://escholarship.org/uc/item/9qz8s2df; https://escholarship.org/content/qt9qz8s2df/qt9qz8s2df.pdf; https://doi.org/10.1016/j.jpainsymman.2022.06.004 |
| Rights: |
public |
| Accession Number: |
edsbas.32A67C88 |
| Database: |
BASE |