1 Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute , Boston, Massachusetts.
2 Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital , Boston, Massachusetts.
J Palliat Med. 2018 Mar;21(S2):S17-S27. doi: 10.1089/jpm.2017.0459. Epub 2017 Nov 1.
High-quality care for seriously ill patients aligns treatment with their goals and values. Failure to achieve "goal-concordant" care is a medical error that can harm patients and families. Because communication between clinicians and patients enables goal concordance and also affects the illness experience in its own right, healthcare systems should endeavor to measure communication and its outcomes as a quality assessment. Yet, little consensus exists on what should be measured and by which methods.
To propose measurement priorities for serious illness communication and its anticipated outcomes, including goal-concordant care.
We completed a narrative review of the literature to identify links between serious illness communication, goal-concordant care, and other outcomes. We used this review to identify gaps and opportunities for quality measurement in serious illness communication.
Our conceptual model describes the relationship between communication, goal-concordant care, and other relevant outcomes. Implementation-ready measures to assess the quality of serious illness communication and care include (1) the timing and setting of serious illness communication, (2) patient experience of communication and care, and (3) caregiver bereavement surveys that include assessment of perceived goal concordance of care. Future measurement priorities include direct assessment of communication quality, prospective patient or family assessment of care concordance with goals, and assessment of the bereaved caregiver experience.
Improving serious illness care necessitates ensuring that high-quality communication has occurred and measuring its impact. Measuring patient experience and receipt of goal-concordant care should be our highest priority. We have the tools to measure both.
为重病患者提供高质量的护理需要将治疗与他们的目标和价值观保持一致。未能实现“目标一致”的护理是一种医疗错误，会对患者和家属造成伤害。由于临床医生和患者之间的沟通可以实现目标一致性，并且本身也会影响疾病体验，医疗保健系统应该努力衡量沟通及其结果作为质量评估。然而，对于应该衡量什么以及用哪些方法，几乎没有达成共识。
提出严重疾病沟通及其预期结果（包括目标一致的护理）的测量优先级。
我们对文献进行了叙述性综述，以确定严重疾病沟通、目标一致的护理与其他结果之间的联系。我们利用这一综述来确定严重疾病沟通质量测量中的差距和机会。
我们的概念模型描述了沟通、目标一致的护理和其他相关结果之间的关系。用于评估严重疾病沟通和护理质量的即用型措施包括：（1）严重疾病沟通的时间和环境；（2）患者对沟通和护理的体验；（3）包括评估护理目标一致性的照顾者丧亲调查。未来的测量重点包括对沟通质量的直接评估、对患者或家属对护理与目标一致性的前瞻性评估，以及对丧亲照顾者体验的评估。
改善严重疾病护理需要确保高质量的沟通已经发生，并衡量其影响。衡量患者体验和获得目标一致的护理应该是我们的首要任务。我们已经有了衡量这两者的工具。
