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.
Key Words
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Article info
Publication history
Published online: June 11, 2022
Accepted:
June 7,
2022
Identification
Copyright
© 2022 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
