Did a Goals-of-Care Discussion Happen? Differences in the Occurrence of Goals-of-Care Discussions as Reported by Patients, Clinicians, and in the Electronic Health Record.
Goals-of-care
end-of-life
palliative care
Journal
Journal of pain and symptom management
ISSN: 1873-6513
Titre abrégé: J Pain Symptom Manage
Pays: United States
ID NLM: 8605836
Informations de publication
Date de publication:
02 2019
02 2019
Historique:
received:
27
08
2018
revised:
24
10
2018
accepted:
25
10
2018
pubmed:
6
11
2018
medline:
18
3
2020
entrez:
5
11
2018
Statut:
ppublish
Résumé
Goals-of-care discussions are associated with improved end-of-life care for patients and therefore may be used as a process measure in quality improvement, research, and reimbursement programs. To examine three methods to assess occurrence of a goals-of-care discussion-patient report, clinician report, and documentation in the electronic health record (EHR)-at a clinic visit for seriously ill patients and determine whether each method is associated with patient-reported receipt of goal-concordant care. We conducted a secondary analysis of a multicenter cluster-randomized trial, with 494 patients and 124 clinicians caring for them. Self-reported surveys collected from patients and clinicians two weeks after a clinic visit assessed occurrence of a goals-of-care discussion. Documentation of a goals-of-care discussion was abstracted from the EHR. Patient-reported receipt of goal-concordant care was assessed by survey two weeks after the visit. Fifty-two percent of patients reported occurrence of a goals-of-care discussion at the clinic visit; clinicians reported occurrence of a discussion at 66% of visits. EHR documentation occurred in 42% of visits (P < 0.001 for each compared with other two). Patients who reported occurrence of a goals-of-care discussion at the visit were more likely to report receipt of goal-concordant care than patients who reported no discussion (β 0.441, 95% CI 0.190-0.692; P = 0.001). Neither occurrence of a discussion by clinician report nor by EHR documentation was associated with goal-concordant care. Different approaches to assess goals-of-care discussions give differing results, yet each may have advantages. Patient report is most likely to correlate with patient-reported receipt of goal-concordant care.
Identifiants
pubmed: 30391656
pii: S0885-3924(18)31054-6
doi: 10.1016/j.jpainsymman.2018.10.507
pmc: PMC6348015
mid: NIHMS1511406
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
251-259Subventions
Organisme : NHLBI NIH HHS
ID : T32 HL007287
Pays : United States
Organisme : NHLBI NIH HHS
ID : T32 HL125195
Pays : United States
Informations de copyright
Copyright © 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Références
J Am Geriatr Soc. 2003 Oct;51(10):1398-403
pubmed: 14511159
J Am Geriatr Soc. 2000 May;48(S1):S44-51
pubmed: 10809456
Chest. 2012 Mar;141(3):726-735
pubmed: 21940765
Patient Educ Couns. 2005 Feb;56(2):139-46
pubmed: 15653242
JAMA. 2002 Aug 14;288(6):756-64
pubmed: 12169083
JAMA Intern Med. 2018 Jul 1;178(7):930-940
pubmed: 29802770
J Palliat Med. 2007 Jun;10(3):728-40
pubmed: 17592985
JAMA Intern Med. 2017 Sep 1;177(9):1361-1366
pubmed: 28672373
Am J Epidemiol. 1989 Jan;129(1):125-37
pubmed: 2910056
J Palliat Med. 2018 Mar;21(S2):S17-S27
pubmed: 29091522
Fed Regist. 2015 Nov 16;80(220):70885-1386
pubmed: 26571548
JAMA. 2008 Oct 8;300(14):1665-73
pubmed: 18840840
Health Policy. 2015 Nov;119(11):1482-9
pubmed: 26421597
Palliat Med. 2006 Dec;20(8):745-54
pubmed: 17148529
AIDS. 1999 Jun 18;13(9):1123-31
pubmed: 10397544
JAMA Intern Med. 2013 May 13;173(9):778-87
pubmed: 23545563
Pharmacoeconomics. 2016 Mar;34(3):273-84
pubmed: 26589411
Ann Intern Med. 2010 Aug 17;153(4):256-61
pubmed: 20713793
CA Cancer J Clin. 2012 Jan-Feb;62(1):10-29
pubmed: 22237781
J Pain Symptom Manage. 2018 Oct;56(4):530-540.e6
pubmed: 30025937
Arch Intern Med. 2009 Mar 9;169(5):480-8
pubmed: 19273778
J Pain Symptom Manage. 2017 May;53(5):821-832.e1
pubmed: 28062339
J Pain Symptom Manage. 2018 Feb;55(2):245-255.e8
pubmed: 28865870
J Palliat Med. 2006 Oct;9(5):1086-98
pubmed: 17040146
J Pain Symptom Manage. 2016 Sep;52(3):386-94
pubmed: 27265813
J Gen Intern Med. 1995 Apr;10(4):179-86
pubmed: 7790978
BMJ. 2010 Mar 23;340:c1345
pubmed: 20332506
Am J Public Health. 1989 Mar;79(3):340-9
pubmed: 2916724
J Am Geriatr Soc. 2002 Mar;50(3):496-500
pubmed: 11943046
Am J Public Health. 2004 Dec;94(12):2084-90
pubmed: 15569958
Lancet. 2005 May 28-Jun 3;365(9474):1877-89
pubmed: 15924986
Eur Respir J. 2004 Aug;24(2):200-5
pubmed: 15332385
Health Aff (Millwood). 2017 Jul 1;36(7):1265-1273
pubmed: 28679814
Am J Respir Crit Care Med. 1996 Oct;154(4 Pt 1):959-67
pubmed: 8887592
J Palliat Med. 2018 Apr;21(4):522-528
pubmed: 29360417
JAMA. 1995 Nov 22-29;274(20):1591-8
pubmed: 7474243
Aliment Pharmacol Ther. 2005 Dec;22(11-12):1079-89
pubmed: 16305721