Content of Serious Illness Care conversation documentation is associated with goals of care orders-a quantitative evaluation in hospital.
Advance care planning
Communication
Goals of care
Hospitals
Serious illness
Journal
BMC palliative care
ISSN: 1472-684X
Titre abrégé: BMC Palliat Care
Pays: England
ID NLM: 101088685
Informations de publication
Date de publication:
29 Jun 2022
29 Jun 2022
Historique:
received:
20
09
2021
accepted:
15
06
2022
entrez:
28
6
2022
pubmed:
29
6
2022
medline:
1
7
2022
Statut:
epublish
Résumé
The Serious Illness Care Program (SICP) increases quality of documentation about patients' values and priorities, but it is not known whether patient characteristics and goals of care are associated with the elements documented. The purpose of this study was to explore for associations between the quantity and type of elements documented after SICP conversations with patient characteristics and goals of care order. Documentation of SICP conversations by internal medicine physicians with hospitalized patients was evaluated in a retrospective chart review between March 2018 to December 2019. The conversations occurred after SICP implementation in a Tertiary Hospital, Medical teaching unit which uses "Goals of Care Designation" (GCD) medical orders to communicate a patient's general intent, specific interventions, and preferred locations of care. A validated SICP codebook was used to determine the frequency of conversation elements documented for (1) Goals and Values; (2) Prognosis/illness understanding; (3) End-of-life care planning and (4) GCD/Life-sustaining treatment preferences. Univariate and multivariate generalized linear models were used to analyze associations between quantity of elements documented and patient characteristics (age, gender, frailty, language spoken and GCD). Of 175 SICP conversations documented, in the univariate analysis more goals and values were documented for patients who understand/speak English (0.89; 95% CI: 0.14 - 1.63) and more content was recorded for patients with a non-resuscitative GCD focus ("Medical": 2.42; 95% CI: 1.51 - 3.33; "Comfort": 1.06; 95% CI: 0.24 - 1.88) although not in all domains. In the multivariate analysis, controlling for age, gender, language and frailty, the association between content scores and GCD remained highly significant. Patients with a non-resuscitative GCD had higher total domain scores than those with a resuscitative GCD ("Medical": 1.27 95% CI: 0.42-2.13; "Comfort": 2.67, 95% CI:1.71-3.62). The type of content documented by physicians after a SICP conversation is associated with the patient's goals of care.
Sections du résumé
BACKGROUND
BACKGROUND
The Serious Illness Care Program (SICP) increases quality of documentation about patients' values and priorities, but it is not known whether patient characteristics and goals of care are associated with the elements documented. The purpose of this study was to explore for associations between the quantity and type of elements documented after SICP conversations with patient characteristics and goals of care order.
METHODS
METHODS
Documentation of SICP conversations by internal medicine physicians with hospitalized patients was evaluated in a retrospective chart review between March 2018 to December 2019. The conversations occurred after SICP implementation in a Tertiary Hospital, Medical teaching unit which uses "Goals of Care Designation" (GCD) medical orders to communicate a patient's general intent, specific interventions, and preferred locations of care. A validated SICP codebook was used to determine the frequency of conversation elements documented for (1) Goals and Values; (2) Prognosis/illness understanding; (3) End-of-life care planning and (4) GCD/Life-sustaining treatment preferences. Univariate and multivariate generalized linear models were used to analyze associations between quantity of elements documented and patient characteristics (age, gender, frailty, language spoken and GCD).
RESULTS
RESULTS
Of 175 SICP conversations documented, in the univariate analysis more goals and values were documented for patients who understand/speak English (0.89; 95% CI: 0.14 - 1.63) and more content was recorded for patients with a non-resuscitative GCD focus ("Medical": 2.42; 95% CI: 1.51 - 3.33; "Comfort": 1.06; 95% CI: 0.24 - 1.88) although not in all domains. In the multivariate analysis, controlling for age, gender, language and frailty, the association between content scores and GCD remained highly significant. Patients with a non-resuscitative GCD had higher total domain scores than those with a resuscitative GCD ("Medical": 1.27 95% CI: 0.42-2.13; "Comfort": 2.67, 95% CI:1.71-3.62).
CONCLUSION
CONCLUSIONS
The type of content documented by physicians after a SICP conversation is associated with the patient's goals of care.
Identifiants
pubmed: 35764991
doi: 10.1186/s12904-022-01006-2
pii: 10.1186/s12904-022-01006-2
pmc: PMC9241276
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
116Subventions
Organisme : Canadian Frailty Network
ID : TG2013-03
Informations de copyright
© 2022. The Author(s).
Références
JAMA Intern Med. 2013 May 13;173(9):778-87
pubmed: 23545563
J Immigr Minor Health. 2018 Oct;20(5):1277-1287
pubmed: 29124502
J Chiropr Med. 2016 Jun;15(2):155-63
pubmed: 27330520
Healthc (Amst). 2021 Jun;9(2):100510
pubmed: 33517037
J Palliat Med. 2021 Jan;24(1):53-62
pubmed: 32580676
JAMA Intern Med. 2019 Jun 1;179(6):751-759
pubmed: 30870563
JAMA Oncol. 2019 Jun 01;5(6):801-809
pubmed: 30870556
CMAJ Open. 2020 Jun 19;8(2):E448-E454
pubmed: 32561591
Health Aff (Millwood). 2017 Jul 1;36(7):1258-1264
pubmed: 28679813
JAMA Intern Med. 2014 Dec;174(12):1994-2003
pubmed: 25330167
CMAJ. 2005 Aug 30;173(5):489-95
pubmed: 16129869
Ann Intern Med. 2010 Aug 17;153(4):256-61
pubmed: 20713793
Palliat Med. 2014 Sep;28(8):1000-25
pubmed: 24651708
BMJ Support Palliat Care. 2015 Mar;5(1):54-62
pubmed: 24644192