Patient-provider care goal concordance: implications for palliative care decisions

Area of Science:

• Medical Ethics
• Healthcare Quality Improvement
• Patient-Centered Care

Background:

• Goal-concordant care is essential for high-quality medical treatment, aligning patient preferences with clinical decisions.
• Patient care goals, whether curative or palliative, are often poorly communicated and inaccurately predicted by healthcare providers.
• Providers' own treatment goals can bias their perceptions of patients' goals, potentially leading to goal-discordant care.

Purpose of the Study:

• To investigate the extent of goal discordance between healthcare providers' own care preferences and their perceptions of patients' care goals.
• To examine the relationship between providers' personal care goals and their willingness to deliver palliative care.
• To assess how providers' predictions of patient goals influence their willingness to provide palliative care.

Main Methods:

• Utilized data from 492 U.S. healthcare providers recruited via an online panel in 2017.
• Providers reported their own care goals (curative vs. palliative) and their perceptions of their patients' care goals.
• Assessed providers' willingness to deliver palliative care.

Main Results:

• A significant minority (28%) of providers reported care goals that differed from their patients'.
• Providers were more inclined to prioritize palliative care for themselves than they predicted for their patients.
• Providers' willingness to offer palliative care correlated with their own palliative preferences, not their perceptions of patient goals.

Conclusions:

• Healthcare provider bias, stemming from projecting personal goals onto patients, can result in care that does not align with patient preferences.
• Improving communication about care goals and implementing strategies to mitigate provider projection bias are necessary steps toward achieving goal-concordant care.
• Interventions targeting provider bias may enhance the alignment of medical treatment with individual patient values and desired outcomes.