Patient-Reported Receipt of Goal-Concordant Care Among Seriously Ill Outpatients—Prevalence and Associated Factors

Goal-concordant care is an important indicator of high-quality care in serious illness. To estimate the prevalence of patient-reported receipt of goal-concordant care among seriously ill outpatients and identify factors associated with the absence of patient-reported goal concordance. Analysis of en...

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Veröffentlicht in:Journal of pain and symptom management Jg. 60; H. 4; S. 765 - 773
Hauptverfasser: Modes, Matthew E., Heckbert, Susan R., Engelberg, Ruth A., Nielsen, Elizabeth L., Curtis, J. Randall, Kross, Erin K.
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States Elsevier Inc 01.10.2020
Elsevier Limited
Schlagworte:
advance care planning
Anesthesia
Discomfort
end-of-life
Enrollments
Goal-concordant care
goals
goals-of-care
Health care
Health services
Illnesses
Life
Life goals
Objectives
Outpatients
Pain
Pain Medicine
palliative care
Patient care planning
Patients
preferences
Quality of care
Risk factors
serious illness
values
preferences
goals-of-care
Goal-concordant care
values
serious illness
end-of-life
palliative care
advance care planning
goals
ISSN:0885-3924, 1873-6513, 1873-6513
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Zusammenfassung:Goal-concordant care is an important indicator of high-quality care in serious illness. To estimate the prevalence of patient-reported receipt of goal-concordant care among seriously ill outpatients and identify factors associated with the absence of patient-reported goal concordance. Analysis of enrollment surveys from a multicenter cluster-randomized trial of outpatients with serious illness. Patients reported their prioritized health care goal and the focus of their current medical care; these items were matched to define receipt of goal-concordant care. Of 405 patients with a prioritized health care goal, 58% reported receipt of goal-concordant care, 17% goal-discordant care, and 25% were uncertain of the focus of their care. Patient-reported receipt of goal concordance differed by patient goal. For patients who prioritized extending life, 86% reported goal-concordant care, 2% goal-discordant care, and 12% were uncertain of the focus of their care. For patients who prioritized relief of pain and discomfort, 51% reported goal-concordant care, 21% goal-discordant care, and 28% were uncertain of the focus of their care. Patients who prioritized a goal of relief of pain and discomfort were more likely to report goal-discordant care than patients who prioritized a goal of extending life (relative risk ratio 22.20; 95% CI 4.59, 107.38). Seriously ill outpatients who prioritize a goal of relief of pain and discomfort are less likely to report receipt of goal-concordant care than patients who prioritize extending life. Future interventions designed to improve receipt of goal-concordant care should focus on identifying patients who prioritize relief of pain and discomfort and promoting care aligned with that goal.
Bibliographie:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
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ISSN:0885-3924
1873-6513
1873-6513
DOI:10.1016/j.jpainsymman.2020.04.026