Laura P Gelfman1, Harriet Mather2, Karen McKendrick2, Angela Y Wong3, Mathew D Hutchinson4, Rachel J Lampert5, Hannah I Lipman6, Daniel D Matlock7, Keith M Swetz8, Sean P Pinney9, R Sean Morrison10, Nathan E Goldstein10. 1. Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Geriatric Research Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY. Electronic address: Laura.Gelfman@mssm.edu. 2. Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY. 3. Palo Alto Medical Foundation, Sunnyvale, CA. 4. Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona College of Medicine Tucson, Tucson, AZ. 5. Department of Internal Medicine, Section of Cardiology, Yale University School of Medicine. 6. Hackensack Meridian Health, Hackensack, NJ; Hackensack Meridian School of Medicine. 7. Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO; VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, Colorado. 8. Birmingham Veterans Affairs Medical Center; Department of Medicine and UAB Center for Palliative and Supportive Care, University of Alabama Birmingham, Birmingham, AL. 9. Division of Cardiology, UChicago Medicine, Chicago, IL. 10. Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Geriatric Research Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY.
Abstract
IMPORTANCE: Despite efforts to enhance serious illness communication, patients with advanced heart failure (HF) lack prognostic understanding. OBJECTIVES: To determine rate of concordance between HF patients' estimation of their prognosis and their physician's estimate of the patient's prognosis, and to compare patient characteristics associated with concordance. DESIGN: Cross-sectional analysis of a cluster randomized controlled trial with 24-month follow-up and analysis completed on 09/01/2020. Patients were enrolled in inpatient and outpatient settings between September 2011 to February 2016 and data collection continued until the last quarter of 2017. SETTING: Six teaching hospitals in the U.S. PARTICIPANTS: Patients with advanced HF and implantable cardioverter defibrillators (ICDs) at high risk of death. Of 537 patients in the parent study, 407 had complete data for this analysis. INTERVENTION: A multi-component communication intervention on conversations between HF clinicians and their patients regarding ICD deactivation and advance care planning. MAIN OUTCOME(S) AND MEASURE(S): Patient self-report of prognosis and physician response to the "surprise question" of 12-month prognosis. Patient-physician prognostic concordance (PPPC) measured in percentage agreement and kappa. Bivariate analyses of characteristics of patients with and without PPPC. RESULTS: Among 407 patients (mean age 62.1 years, 29.5% female, 42.4% non-white), 300 (73.7%) dyads had non-PPPC; of which 252 (84.0%) reported a prognosis >1 year when their physician estimated <1 year. Only 107 (26.3%) had PPPC with prognosis of ≤ 1 year (n=20 patients) or > 1 year (n=87 patients); (Κ = -0.20, p = 1.0). Of those with physician estimated prognosis of < 1 year, non-PPPC was more likely among patients with lower symptom burden- number and severity (both p ≤.001), without completed advance directive (p=.001). Among those with physician prognosis estimate > 1 year, no patient characteristic was associated with PPPC or non-PPPC. CONCLUSIONS AND RELEVANCE: Non-PPPC between HF patients and their physicians is high. HF patients are more optimistic than clinicians in estimating life expectancy. These data demonstrate there are opportunities to improve the quality of prognosis disclosure between patients with advanced HF and their physicians. Interventions to improve PPPC might include serious illness communication training. Published by Elsevier Inc.
IMPORTANCE: Despite efforts to enhance serious illness communication, patients with advanced heart failure (HF) lack prognostic understanding. OBJECTIVES: To determine rate of concordance between HF patients' estimation of their prognosis and their physician's estimate of the patient's prognosis, and to compare patient characteristics associated with concordance. DESIGN: Cross-sectional analysis of a cluster randomized controlled trial with 24-month follow-up and analysis completed on 09/01/2020. Patients were enrolled in inpatient and outpatient settings between September 2011 to February 2016 and data collection continued until the last quarter of 2017. SETTING: Six teaching hospitals in the U.S. PARTICIPANTS: Patients with advanced HF and implantable cardioverter defibrillators (ICDs) at high risk of death. Of 537 patients in the parent study, 407 had complete data for this analysis. INTERVENTION: A multi-component communication intervention on conversations between HF clinicians and their patients regarding ICD deactivation and advance care planning. MAIN OUTCOME(S) AND MEASURE(S): Patient self-report of prognosis and physician response to the "surprise question" of 12-month prognosis. Patient-physician prognostic concordance (PPPC) measured in percentage agreement and kappa. Bivariate analyses of characteristics of patients with and without PPPC. RESULTS: Among 407 patients (mean age 62.1 years, 29.5% female, 42.4% non-white), 300 (73.7%) dyads had non-PPPC; of which 252 (84.0%) reported a prognosis >1 year when their physician estimated <1 year. Only 107 (26.3%) had PPPC with prognosis of ≤ 1 year (n=20 patients) or > 1 year (n=87 patients); (Κ = -0.20, p = 1.0). Of those with physician estimated prognosis of < 1 year, non-PPPC was more likely among patients with lower symptom burden- number and severity (both p ≤.001), without completed advance directive (p=.001). Among those with physician prognosis estimate > 1 year, no patient characteristic was associated with PPPC or non-PPPC. CONCLUSIONS AND RELEVANCE: Non-PPPC between HF patients and their physicians is high. HF patients are more optimistic than clinicians in estimating life expectancy. These data demonstrate there are opportunities to improve the quality of prognosis disclosure between patients with advanced HF and their physicians. Interventions to improve PPPC might include serious illness communication training. Published by Elsevier Inc.
Authors: Clyde W Yancy; Mariell Jessup; Biykem Bozkurt; Javed Butler; Donald E Casey; Mark H Drazner; Gregg C Fonarow; Stephen A Geraci; Tamara Horwich; James L Januzzi; Maryl R Johnson; Edward K Kasper; Wayne C Levy; Frederick A Masoudi; Patrick E McBride; John J V McMurray; Judith E Mitchell; Pamela N Peterson; Barbara Riegel; Flora Sam; Lynne W Stevenson; W H Wilson Tang; Emily J Tsai; Bruce L Wilkoff Journal: J Am Coll Cardiol Date: 2013-06-05 Impact factor: 24.094
Authors: Nathan E Goldstein; Harriet Mather; Karen McKendrick; Laura P Gelfman; Mathew D Hutchinson; Rachel Lampert; Hannah I Lipman; Daniel D Matlock; Jacob J Strand; Keith M Swetz; Jill Kalman; Jean S Kutner; Sean Pinney; R Sean Morrison Journal: J Am Coll Cardiol Date: 2019-10-01 Impact factor: 24.094
Authors: Amrut V Ambardekar; Jennifer T Thibodeau; Adam D DeVore; Michelle M Kittleson; Rhondalyn C Forde-McLean; Maryse Palardy; Maria M Mountis; Linda Cadaret; Jeffrey J Teuteberg; Salpy V Pamboukian; Rongbing Xie; Lynne W Stevenson; Garrick C Stewart Journal: JACC Heart Fail Date: 2017-08-16 Impact factor: 12.035
Authors: Madhav Narayan; Jacqueline Jones; Laura B Portalupi; Colleen K McIlvennan; Daniel D Matlock; Larry A Allen Journal: J Card Fail Date: 2016-12-21 Impact factor: 5.712
Authors: Elizabeth J Lilley; Sean A Gemunden; Gentian Kristo; Navin Changoor; John W Scott; Elizabeth Rickerson; Naomi Shimizu; Ali Salim; Zara Cooper Journal: J Palliat Med Date: 2016-11-01 Impact factor: 2.947
Authors: R K Portenoy; H T Thaler; A B Kornblith; J M Lepore; H Friedlander-Klar; E Kiyasu; K Sobel; N Coyle; N Kemeny; L Norton Journal: Eur J Cancer Date: 1994 Impact factor: 9.162
Authors: Laura P Gelfman; Rebecca L Sudore; Harriet Mather; Karen McKendrick; Mathew D Hutchinson; Rachel J Lampert; Hannah I Lipman; Daniel D Matlock; Keith M Swetz; Sean P Pinney; R Sean Morrison; Nathan E Goldstein Journal: Circ Heart Fail Date: 2020-09-02 Impact factor: 8.790