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Rethinking fundamental assumptions: SUPPORT's implications for future reform. Study to Understand Prognoses and
1Center to Improve Care of the Dying, The George Washington University, Washington, DC, USA.
Journal of the American Geriatrics Society
|May 16, 2000
Summary
The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT) intervention failed to improve end-of-life care communication and decision-making. System-level changes and routine practice improvements may be more effective than individual patient counseling.
Area of Science:
- Medical ethics
- Health services research
- Clinical communication
Background:
- The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT) intervention aimed to improve end-of-life care.
- Despite planned counseling and information delivery, the intervention did not significantly alter communication, decision-making, or treatment patterns.
Purpose of the Study:
- To investigate if improving individual patient decision-making is the optimal strategy for enhancing end-of-life care.
- To explore the potential effectiveness of improving routine healthcare practices.
Main Methods:
- Synthesis of findings from the SUPPORT trial.
- Exploration of conceptual models and their alignment with empirical data.
- Analysis of factors influencing healthcare reform.
Main Results:
- The model of improved decision-making has problematic underlying assumptions.
- Implementing shared decision-making interventions in practice proved challenging.
- Patient care is strongly influenced by established practice patterns and social expectations.
Conclusions:
- The SUPPORT intervention's lack of impact may stem from deeply ingrained psychological and social factors in current practices.
- System-level innovations, such as quality improvement initiatives and revised financing incentives, offer more promising avenues for improving end-of-life care.
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