Division of Pulmonary and Critical Care Medicine (M.E.M), Cedars-Sinai Medical Center, Los Angeles, California, USA.
Division of Pulmonary (R.A.E., E.L.N., J.R.C., E.K.K.), Critical Care and Sleep Medicine, University of Washington, Seattle, Washington, USA; Cambia Palliative Care Center of Excellence (R.A.E., E.L.N., L.C.B., J.R.C., E.K.K.), University of Washington, Seattle, Washington, USA.
J Pain Symptom Manage. 2022 Oct;64(4):410-418. doi: 10.1016/j.jpainsymman.2022.06.004. Epub 2022 Jun 11.
Seriously ill patients whose prioritized healthcare goals are understood by their clinicians are likely better positioned to receive goal-concordant care.
To examine the proportion of seriously ill patients whose prioritized healthcare goal is accurately perceived by their clinician and identify factors associated with accurate perception.
Secondary analysis of a multicenter cluster-randomized trial of outpatients with serious illness and their clinicians. Approximately two weeks after a clinic visit, patients reported their current prioritized healthcare goal- extending life over relief of pain and discomfort, or relief of pain and discomfort over extending life - and clinicians reported their perception of their patients' current prioritized healthcare goal; matching these items defined accurate perception.
Of 252 patients with a prioritized healthcare goal, 60% had their goal accurately perceived by their clinician, 27% were cared for by clinicians who perceived prioritization of the alternative goal, and 13% had their clinician answer unsure. Patients who were older (OR 1.03 per year; 95%CI 1.01, 1.05), had stable goals (OR 2.52; 95%CI 1.26, 5.05), and had a recent goals-of-care discussion (OR 1.78, 95%CI 1.00, 3.16) were more likely to have their goals accurately perceived.
A majority of seriously ill outpatients are cared for by clinicians who accurately perceive their patients' prioritized healthcare goals. However, a substantial portion are not and may be at higher risk for goal-discordant care. Interventions that facilitate goals-of-care discussions may help align care with goals, as recent discussions were associated with accurate perceptions of patients' prioritized goals.
患者的临床医生理解其优先医疗目标的重病患者，更有可能获得与目标一致的护理。
检查了解患者优先医疗目标的比例准确地被其临床医生感知，并确定与准确感知相关的因素。
对患有严重疾病的门诊患者及其临床医生的多中心集群随机试验的二次分析。在就诊后大约两周，患者报告他们目前的优先医疗目标-延长生命优于缓解疼痛和不适，或缓解疼痛和不适优于延长生命-临床医生报告他们对患者当前优先医疗目标的感知；这些项目的匹配定义为准确感知。
在 252 名有优先医疗目标的患者中，60%的患者的目标被其临床医生准确感知，27%的患者由感知替代目标优先的临床医生治疗，13%的患者的临床医生回答不确定。年龄较大的患者（OR 1.03/年；95%CI 1.01，1.05）、目标稳定的患者（OR 2.52；95%CI 1.26，5.05）和最近进行过目标治疗讨论的患者（OR 1.78，95%CI 1.00，3.16）更有可能被准确感知到他们的目标。
大多数重病门诊患者都由准确感知其患者优先医疗目标的临床医生治疗。然而，仍有相当一部分患者未被准确感知，他们可能面临更高的目标不一致风险。促进目标治疗讨论的干预措施可能有助于使治疗与目标保持一致，因为最近的讨论与准确感知患者的优先目标有关。
