Measuring Goal-Concordant Care: Results and Reflections From Secondary Analysis of a Trial to Improve Serious Illness Communication

Many consider goal-concordant care (GCC) to be the most important of advance care planning and palliative care. Researchers face significant challenges in attempting to measure this outcome. We conducted a randomized controlled trial to assess the effects of a system-level intervention to improve se...

Full description

Saved in:
Bibliographic Details
Published in:Journal of pain and symptom management 2020-11, Vol.60 (5), p.889-897.e2
Main Authors: Sanders, Justin J., Miller, Kate, Desai, Meghna, Geerse, Olaf P., Paladino, Joanna, Kavanagh, Jane, Lakin, Joshua R., Neville, Bridget A., Block, Susan D., Fromme, Erik K., Bernacki, Rachelle
Format: Article
Language:English
Subjects:
Advance Care Planning
Advance directives
Cancer
Care plans
clinical trial
Clinical trials
Communication
Goal-concordant care
Goals
Humans
Illnesses
Intervention
Measurement
Neoplasms - therapy
Objectives
Palliative Care
Patient care planning
Polls & surveys
Priorities
Prioritizing
Ratings & rankings
serious illness communication
study methods
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Many consider goal-concordant care (GCC) to be the most important of advance care planning and palliative care. Researchers face significant challenges in attempting to measure this outcome. We conducted a randomized controlled trial to assess the effects of a system-level intervention to improve serious illness communication on GCC and other outcomes. To describe our measurement approach to GCC, present findings from a post-hoc analysis of trial data, and discuss lessons learned about measuring GCC. Using trial data collected to measure GCC, we analyzed ratings and rankings from a nonvalidated survey of patient priorities in the setting of advanced cancer, the Life Priorities Scale, and compared outcomes with correlative measures. Participants commonly rated several predetermined and literature-derived priorities as important but did so in ways that were commonly incongruent with rankings. Ratings were frequently stable over time; rankings less so. Rankings are more likely to help assess the degree to which care is goal concordant but may be best augmented by corollary measures that signal achievement of a given priority. Measuring GCC remains a fundamental challenge to palliative care researchers. Ratings attest to the fact that many things matter to patients; however, rankings can better determine what matters most. Insights gained from our experience may guide future research aiming to use this outcome to assess the effect of intervention to improve serious illness care.
ISSN:0885-3924
1873-6513
DOI:10.1016/j.jpainsymman.2020.06.023