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Goal Communication in Palliative Care Decision-Making Consultations
Robert Gramling1, Mechelle Sanders1, Susan Ladwig1
1University of Rochester, Rochester, New York, USA.
Journal of Pain and Symptom Management
|May 31, 2015
Summary
Palliative care consultations frequently involve patient goal discussions. Existential suffering significantly increases the frequency and types of goals expressed, highlighting its impact on care.
Area of Science:
- Palliative Care Research
- Clinical Communication Studies
- Patient-Centered Outcomes
Background:
- Palliative care (PC) aims to improve patient-centered outcomes, but the underlying mechanisms are not well understood.
- Identifying and prioritizing patient goals is central to patient-centered care and a primary reason for PC referral.
- Empirical data on goal expression within naturalistic PC settings is limited.
Purpose of the Study:
- To investigate the frequency, types, and influencing factors of goal expression during palliative care consultations.
- To characterize the nature of goal communication in PC.
Main Methods:
- A cross-sectional observational study involving 72 audio-recorded palliative care consultations.
- Consultations focused on goals of care clarification or end-of-life decision-making for hospitalized patients and families.
- Digital audio recordings were systematically coded and linked with clinical records and clinician interviews.
Main Results:
- Goal expressions were frequent in PC consultations, encompassing both length-of-life and quality-of-life domains.
- The presence of existential suffering within conversations was significantly associated with a higher number and variety of expressed goals.
Conclusions:
- Goal communication is a common and integral component of palliative care decision-making.
- Existential suffering appears to be a strong determinant of goal expression in palliative care settings.
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