How well do documented goals-of-care discussions for patients with stage IV cancer reflect communication best practices?

BMC Palliative Care

Natalie C. Ernecoff¹  Gary S. Winzelberg²  Frances A. Collichio³  William A. Wood³  Laura C. Hanson⁴  Kathryn L. Wessell⁴ 

[1] Department of Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine;Department of Medicine, Division of Geriatric Medicine and Palliative Care Program, University of North Carolina;Department of Medicine, Division of Hematology/Oncology, University of North Carolina;Sheps Center for Health Services Research, University of North Carolina;

关键词: Metastatic;    Decision making;    Palliative care;    Electronic health record;   

DOI  :  10.1186/s12904-021-00733-2

来源: DOAJ

【 摘 要 】

Abstract Background Written clinical communication regarding patients’ disease understanding and values may facilitate goal-concordant care, yet little is known about the quality of electronic health record (EHR) documentation. We sought to (1) describe frequency of communication best practices in EHR-documented goals-of-care discussions, and (2) assess whether templated notes improve quality of documentation. Methods Researchers pulled text of EHR-documented goals-of-care discussions for hospitalized patients with Stage IV cancer from admission to 60-days follow-up. Text was included when in a single encounter the clinician addressed: (a) prognosis and/or illness understanding; and (b) goals and/or treatment options. Researchers qualitatively coded text based on guidelines for communication best practices, and noted if an EHR template was used. Results Forty-two percent (206/492) of patients had EHR-documented goals-of-care discussions. Text frequently described communication of cancer progression (89%), though rarely included prognosis (22%). Text often included patients’ goals and values (83%), and at least on specific treatment decision (82%). Communication about treatments was included for 98% of patients; common examples included cancer treatment (62%), hospice (62%), resuscitation (51%), or intensive care (38%). Clinicians documented making recommendations for 40% of patients. Text addressing patient emotional and spiritual concerns was uncommon (15%). Compared to free text, use of a template was associated with increased documentation of goals and values (80% vs. 61%, p < 0.01), but not other best practices. Conclusion Insights from the study can be used to guide future training and research to study and improve the quality of documentation about goal of care, and its impact on goal-concordant care.

【 授权许可】

Unknown