Comparing Survey and Chart Review Measures for Goal-Concordant Care in a UC System Pragmatic Trial (RP121)

• Published in: Journal of pain and symptom management 2024-05, Vol.67 (5), p.e770-e771
• Main Authors: Buen, Kirsten Inducil, DePaolis-Dickey, Anna, Wenger, Neil S., Rahimi, Maryam, George, Valerie, Patel, Kanan, Sudore, Rebecca, Gibbs, Lisa, Santos, Katherine, Gonzalez, Victor, Lopez, Juan Carlos Antonio, Chau, Aaron J., Walling, Anne
• Format: Article
• Language: English
• ISSN: 0885-3924
• DOI: 10.1016/j.jpainsymman.2024.02.436

1. Participants will self-report the ability to understand that varied approaches to determining goal-concordance are needed to more accurately capture its occurrence. 2. Participants will self-report the ability to evaluate and analyze methods utilized for determining goal-concordance as a way to implement future applications of such methods. Goal-concordant care is considered an important quality measure in palliative care research; however, there is not one standard to measure this concept. We sought to analyze measures of goal-concordance using chart review methods and after-death surveys completed by caregivers, as part of a UC-System pragmatic trial. Goal-concordant care (GCC), an important quality metric in palliative care, lacks a well-defined standard for measurement. To compare the prevalence of GCC using after-death surveys (ADS) to an implicit review of medical records. As part of a pragmatic trial to improve advance care planning (ACP) among seriously ill primary care patients at three University of California health systems, GCC was assessed using two approaches: (1) an ADS question adapted from the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments, comparing patients’ preferences for care at the end-of-life to care received per caregiver report and (2) an implicit review of medical records by a trained abstractor, comparing ACP forms and notes documenting goals of care discussions to care received. Forty-six patients (mean age 74.5, ± 11.5 years, 43% female, 61% white, 83% English-speakers) who died had an ADS completed by caregivers (mean age 61.6, ± 12.8 years, 65% female, 57% white, 89% English speakers) and implicit review of medical records. Based on ADS, 39 (85%) patients received GCC. Implicit chart review indicated 29 patients (63%) received GCC, 1 patient received goal-discordant care, and 16 cases lacked adequate documentation to decide. In 29 cases where implicit review indicated GCC, caregivers for 26 patients (90%) reported GCC. In the 16 cases where GCC could not be implicitly measured from the chart, 13 caregivers (81%) reported GCC. In this sample, GCC was more likely to be confirmed by caregiver report than chart review. Charts lacking documentation of goals of care discussions may trend towards lower rates of GCC as reported by caregivers. These preliminary results provide some evidence of association between chart review and caregiver reports of GCC. Advanced care planning/shared decision m