Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA; Ariadne Labs, Brigham and Women's Hospital & Harvard T. H. Chan School of Public Health, Boston, MA, USA; Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
Care Continuum Management, Brigham & Women's Hospital, Boston, MA, USA.
Healthc (Amst). 2021 Jun;9(2):100510. doi: 10.1016/j.hjdsi.2020.100510. Epub 2021 Jan 28.
Early conversations about patients' goals and values in advancing serious illness (serious illness conversations) can drive better healthcare. However, these conversations frequently happen during acute illness, often near death, without time to realize benefits of early communication.
The Speaking About Goals and Expectations (SAGE) Program, adapted from the Serious Illness Care Program, is a multicomponent intervention designed to foster earlier and more comprehensive serious illness conversations for patients admitted to the hospital. We present a quality improvement study of the SAGE Program assessing older adults admitted to a general medicine service at the Brigham & Women's Hospital in Boston, Massachusetts. Our primary outcomes included the proportion of patients with at least one documented conversation, the timing between first conversation documented and death, the quality of conversations, and their interprofessional nature. Secondary outcomes assessed evaluations of the training and hospital utilization.
We trained 37 clinicians and studied 133 patients split between the SAGE intervention and a comparison population. Intervention patients were more likely to have documented serious illness conversations (89.1% vs. 26.1%, p < 0.001); these conversations occurred earlier (mean of 598.9 vs. 180.8 days before death, p < 0.001) and included more key elements of conversation (mean of 6.56 vs. 1.78, p < 0.001).
This study demonstrated significant differences in the frequency and quality of serious illness conversations completed earlier in the illness course for hospitalized patients.
Programs designed to drive serious illness conversations earlier in the hospital may be an effective way to improve care for patients not reached in the ambulatory setting.
Prospectively designed trial, non-randomized sample.
早期讨论患者在推进重病（重病对话）中的目标和价值观可以改善医疗保健。然而，这些对话经常在急性疾病期间发生，通常在接近死亡时发生，没有时间实现早期沟通的好处。
从重病护理计划改编的“说话关于目标和期望”（SAGE）计划是一种多组分干预措施，旨在促进住院患者更早和更全面的重病对话。我们介绍了 SAGE 计划的质量改进研究，该计划评估了马萨诸塞州波士顿布莱根妇女医院普通内科病房收治的老年患者。我们的主要结果包括至少有一次记录对话的患者比例、首次记录对话与死亡之间的时间间隔、对话的质量及其跨专业性质。次要结果评估了培训和医院利用情况的评估。
我们培训了 37 名临床医生，并对 SAGE 干预组和对照组的 133 名患者进行了研究。干预组患者更有可能有记录的重病对话（89.1% vs. 26.1%，p < 0.001）；这些对话发生得更早（平均为死亡前 598.9 天 vs. 180.8 天，p < 0.001），并且包括更多的对话关键要素（平均 6.56 个 vs. 1.78 个，p < 0.001）。
这项研究表明，住院患者在疾病早期进行重病对话的频率和质量有显著差异。
旨在更早地在医院进行重病对话的计划可能是改善未在门诊环境中接触到的患者护理的有效方法。
前瞻性设计的试验，非随机样本。
