RT Journal Article
SR Electronic
T1 What really matters in end-of-life discussions? Perspectives of patients in hospital with serious illness and their families
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP E679
OP E687
DO 10.1503/cmaj.140673
VO 186
IS 18
A1 You, John J.
A1 Dodek, Peter
A1 Lamontagne, Francois
A1 Downar, James
A1 Sinuff, Tasnim
A1 Jiang, Xuran
A1 Day, Andrew G.
A1 Heyland, Daren K.
A1 
YR 2014
UL http://www.cmaj.ca/content/186/18/E679.abstract
AB Background: The guideline-recommended elements to include in discussions about goals of care with patients with serious illness are mostly based on expert opinion. We sought to identify which elements are most important to patients and their families.Methods: We used a cross-sectional study design involving patients from 9 Canadian hospitals. We asked older adult patients with serious illness and their family members about the occurrence and importance of 11 guideline-recommended elements of goals-of-care discussions. In addition, we assessed concordance between prescribed goals of care and patient preferences, and we measured patient satisfaction with goals-of-care discussions using the Canadian Health Care Evaluation Project (CANHELP) questionnaire.Results: Our study participants included 233 patients (mean age 81.2 yr) and 205 family members (mean age 60.2 yr). Participants reported that clinical teams had addressed individual elements of goals-of-care discussions infrequently (range 1.4%–31.7%). Patients and family members identified the same 5 elements as being the most important to address: preferences for care in the event of life-threatening illness, values, prognosis, fears or concerns, and questions about goals of care. Addressing more elements was associated with both greater concordance between patients’ preferences and prescribed goals of care, and greater patient satisfaction.Interpretation: We identified elements of goals-of-care discussions that are most important to older adult patients in hospital with serious illness and their family members. We found that guideline-recommended elements of goals-of-care discussions are not often addressed by health care providers. Our results can inform interventions to improve the determination of goals of care in the hospital setting.