CONTEXT: Palliative care (PC) promotes patient-centered outcomes, but the mechanisms underlying these effects remain poorly understood. Identifying, clarifying, and prioritizing patients' goals are conceptually fundamental to the process of patient-centeredness and are the main reasons for PC referral. However, very little is empirically known about the content or process of goal expression in the natural setting of PC. OBJECTIVES: To describe the frequency, types, and determinants of goal expression in PC consultations. METHODS: This was a cross-sectional direct observational study of 72 audiorecorded PC consultations with hospitalized patients (and families) referred for PC goals of care clarification or end-of-life decision making. We coded digital audio files using reliable methods and linked conversation codes to clinical record and brief clinician interview data. RESULTS: Goal expressions occurred frequently in PC consultations and addressed both length-of-life and quality-of-life domains. The presence of existential suffering in the conversation was associated with substantially more expressions and types of goals. CONCLUSION: Goal communication is common in PC decision-making settings and strongly influenced by existential suffering.
CONTEXT: Palliative care (PC) promotes patient-centered outcomes, but the mechanisms underlying these effects remain poorly understood. Identifying, clarifying, and prioritizing patients' goals are conceptually fundamental to the process of patient-centeredness and are the main reasons for PC referral. However, very little is empirically known about the content or process of goal expression in the natural setting of PC. OBJECTIVES: To describe the frequency, types, and determinants of goal expression in PC consultations. METHODS: This was a cross-sectional direct observational study of 72 audiorecorded PC consultations with hospitalized patients (and families) referred for PC goals of care clarification or end-of-life decision making. We coded digital audio files using reliable methods and linked conversation codes to clinical record and brief clinician interview data. RESULTS: Goal expressions occurred frequently in PC consultations and addressed both length-of-life and quality-of-life domains. The presence of existential suffering in the conversation was associated with substantially more expressions and types of goals. CONCLUSION: Goal communication is common in PC decision-making settings and strongly influenced by existential suffering.
Authors: Robert Gramling; Kevin Fiscella; Guibo Xing; Michael Hoerger; Paul Duberstein; Sandy Plumb; Supriya Mohile; Joshua J Fenton; Daniel J Tancredi; Richard L Kravitz; Ronald M Epstein Journal: JAMA Oncol Date: 2016-11-01 Impact factor: 31.777
Authors: Robert Gramling; Elizabeth Gajary-Coots; Susan Stanek; Nathalie Dougoud; Heather Pyke; Marie Thomas; Jenica Cimino; Mechelle Sanders; Stewart C Alexander; Ronald Epstein; Kevin Fiscella; David Gramling; Susan Ladwig; Wendy Anderson; Stephen Pantilat; Sally A Norton Journal: BMC Palliat Care Date: 2015-08-19 Impact factor: 3.234