John J You1, Peter Dodek2, Francois Lamontagne2, James Downar2, Tasnim Sinuff2, Xuran Jiang2, Andrew G Day2, Daren K Heyland2. 1. Departments of Medicine, Clinical Epidemiology and Biostatistics (You), McMaster University, Hamilton, Ont.; Division of Critical Care Medicine (Dodek), St. Paul's Hospital; Center for Health Evaluation and Outcome Sciences (Dodek), University of British Columbia, Vancouver, BC; Centre de Recherche Clinique Hôpital Universitaire de Sherbrooke (Lamontagne), Université de Sherbrooke, Sherbrooke, Qué.; Divisions of Critical Care and Palliative Care (Downar), Department of Medicine, University of Toronto; Department of Critical Care Medicine and Sunnybrook Research Institute (Sinuff), Sunnybrook Health Sciences Centre; Interdepartmental Division of Critical Care Medicine (Sinuff), University of Toronto, Toronto, Ont.; Clinical Evaluation Research Unit, Department of Medicine (Jiang, Day, Heyland), Kingston General Hospital, Kingston, Ont.; Department of Community Health and Epidemiology (Heyland), Queen's University, Kingston, Ont. jyou@mcmaster.ca. 2. Departments of Medicine, Clinical Epidemiology and Biostatistics (You), McMaster University, Hamilton, Ont.; Division of Critical Care Medicine (Dodek), St. Paul's Hospital; Center for Health Evaluation and Outcome Sciences (Dodek), University of British Columbia, Vancouver, BC; Centre de Recherche Clinique Hôpital Universitaire de Sherbrooke (Lamontagne), Université de Sherbrooke, Sherbrooke, Qué.; Divisions of Critical Care and Palliative Care (Downar), Department of Medicine, University of Toronto; Department of Critical Care Medicine and Sunnybrook Research Institute (Sinuff), Sunnybrook Health Sciences Centre; Interdepartmental Division of Critical Care Medicine (Sinuff), University of Toronto, Toronto, Ont.; Clinical Evaluation Research Unit, Department of Medicine (Jiang, Day, Heyland), Kingston General Hospital, Kingston, Ont.; Department of Community Health and Epidemiology (Heyland), Queen's University, Kingston, Ont.
Abstract
BACKGROUND: The guideline-recommended elements to include in discussions about goals of care with patients with serious illness are mostly based on expert opinion. We sought to identify which elements are most important to patients and their families. METHODS: We used a cross-sectional study design involving patients from 9 Canadian hospitals. We asked older adult patients with serious illness and their family members about the occurrence and importance of 11 guideline-recommended elements of goals-of-care discussions. In addition, we assessed concordance between prescribed goals of care and patient preferences, and we measured patient satisfaction with goals-of-care discussions using the Canadian Health Care Evaluation Project (CANHELP) questionnaire. RESULTS: Our study participants included 233 patients (mean age 81.2 yr) and 205 family members (mean age 60.2 yr). Participants reported that clinical teams had addressed individual elements of goals-of-care discussions infrequently (range 1.4%-31.7%). Patients and family members identified the same 5 elements as being the most important to address: preferences for care in the event of life-threatening illness, values, prognosis, fears or concerns, and questions about goals of care. Addressing more elements was associated with both greater concordance between patients' preferences and prescribed goals of care, and greater patient satisfaction. INTERPRETATION: We identified elements of goals-of-care discussions that are most important to older adult patients in hospital with serious illness and their family members. We found that guideline-recommended elements of goals-of-care discussions are not often addressed by health care providers. Our results can inform interventions to improve the determination of goals of care in the hospital setting.
BACKGROUND: The guideline-recommended elements to include in discussions about goals of care with patients with serious illness are mostly based on expert opinion. We sought to identify which elements are most important to patients and their families. METHODS: We used a cross-sectional study design involving patients from 9 Canadian hospitals. We asked older adult patients with serious illness and their family members about the occurrence and importance of 11 guideline-recommended elements of goals-of-care discussions. In addition, we assessed concordance between prescribed goals of care and patient preferences, and we measured patient satisfaction with goals-of-care discussions using the Canadian Health Care Evaluation Project (CANHELP) questionnaire. RESULTS: Our study participants included 233 patients (mean age 81.2 yr) and 205 family members (mean age 60.2 yr). Participants reported that clinical teams had addressed individual elements of goals-of-care discussions infrequently (range 1.4%-31.7%). Patients and family members identified the same 5 elements as being the most important to address: preferences for care in the event of life-threatening illness, values, prognosis, fears or concerns, and questions about goals of care. Addressing more elements was associated with both greater concordance between patients' preferences and prescribed goals of care, and greater patient satisfaction. INTERPRETATION: We identified elements of goals-of-care discussions that are most important to older adult patients in hospital with serious illness and their family members. We found that guideline-recommended elements of goals-of-care discussions are not often addressed by health care providers. Our results can inform interventions to improve the determination of goals of care in the hospital setting.
Authors: Josephine M Clayton; Karen M Hancock; Phyllis N Butow; Martin H N Tattersall; David C Currow; Jonathan Adler; Sanchia Aranda; Kirsten Auret; Fran Boyle; Annette Britton; Richard Chye; Katy Clark; Patricia Davidson; Jan Maree Davis; Afaf Girgis; Sara Graham; Janet Hardy; Kate Introna; John Kearsley; Ian Kerridge; Linda Kristjanson; Peter Martin; Amanda McBride; Anne Meller; Geoffrey Mitchell; Alison Moore; Beverley Noble; Ian Olver; Sharon Parker; Matthew Peters; Peter Saul; Cameron Stewart; Lyn Swinburne; Bernadette Tobin; Kathryn Tuckwell; Patsy Yates Journal: Med J Aust Date: 2007-06-18 Impact factor: 7.738
Authors: Tasnim Sinuff; Peter Dodek; John J You; Doris Barwich; Carolyn Tayler; James Downar; Michael Hartwick; Christopher Frank; Henry T Stelfox; Daren K Heyland Journal: J Pain Symptom Manage Date: 2015-01-24 Impact factor: 3.612
Authors: Daren K Heyland; Peter Dodek; Graeme Rocker; Dianne Groll; Amiram Gafni; Deb Pichora; Sam Shortt; Joan Tranmer; Neil Lazar; Jim Kutsogiannis; Miu Lam Journal: CMAJ Date: 2006-02-28 Impact factor: 8.262
Authors: Daren K Heyland; Doris Barwich; Deb Pichora; Peter Dodek; Francois Lamontagne; John J You; Carolyn Tayler; Pat Porterfield; Tasnim Sinuff; Jessica Simon Journal: JAMA Intern Med Date: 2013-05-13 Impact factor: 21.873
Authors: Daren K Heyland; Deborah J Cook; Graeme M Rocker; Peter M Dodek; Demetrios J Kutsogiannis; Yoanna Skrobik; Xuran Jiang; Andrew G Day; S Robin Cohen Journal: Palliat Med Date: 2010-07-06 Impact factor: 4.762
Authors: William J Ehlenbach; Amber E Barnato; J Randall Curtis; William Kreuter; Thomas D Koepsell; Richard A Deyo; Renee D Stapleton Journal: N Engl J Med Date: 2009-07-02 Impact factor: 91.245
Authors: Deborah Cook; Graeme Rocker; John Marshall; Peter Sjokvist; Peter Dodek; Lauren Griffith; Andreas Freitag; Joseph Varon; Christine Bradley; Mitchell Levy; Simon Finfer; Cindy Hamielec; Joseph McMullin; Bruce Weaver; Stephen Walter; Gordon Guyatt Journal: N Engl J Med Date: 2003-09-18 Impact factor: 91.245
Authors: Andrew S Epstein; Anjali V Desai; Camila Bernal; Danielle Romano; Peter J Wan; Molly Okpako; Kelly Anderson; Kimberly Chow; Dana Kramer; Claudia Calderon; Virginia V Klimek; Robin Rawlins-Duell; Diane L Reidy; Jessica I Goldberg; Elizabeth Cruz; Judith E Nelson Journal: J Pain Symptom Manage Date: 2019-04-26 Impact factor: 3.612
Authors: Michael K Y Wong; Maria Cassandre Medor; Katerina Yelle Labre; Mengzhu Jiang; Jason R Frank; Lisa M Fischer; Warren J Cheung Journal: CMAJ Open Date: 2019-09-16
Authors: Christopher E Cox; Douglas B White; Catherine L Hough; Derek M Jones; Jeremy M Kahn; Maren K Olsen; Carmen L Lewis; Laura C Hanson; Shannon S Carson Journal: Ann Intern Med Date: 2019-01-29 Impact factor: 25.391
Authors: Simon M Cohen; Angelo E Volandes; Michele L Shaffer; Laura C Hanson; Daniel Habtemariam; Susan L Mitchell Journal: J Pain Symptom Manage Date: 2018-09-29 Impact factor: 3.612
Authors: Nicholas G Wysham; May Hua; Catherine L Hough; Stephanie Gundel; Sharron L Docherty; Derek M Jones; Owen Reagan; Haley Goucher; Jessica Mcfarlin; Christopher E Cox Journal: Crit Care Med Date: 2017-04 Impact factor: 7.598