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A Goal-Concordant Prescribing Conceptual Framework: Implications for Practice and Measurement
Summary
Effective medication management in hospice care requires aligning patient goals with clinician priorities. This study proposes a framework to bridge communication gaps and ensure goal-concordant prescribing for seriously ill older adults.
Area of Science:
- Palliative Care
- Geriatric Medicine
- Clinical Pharmacology
Background:
- Medication management in hospice and palliative care aims to optimize benefits and minimize harm.
- A significant challenge is aligning patient/family goals with clinician priorities for end-of-life care.
- Effective communication is crucial for integrating patient values into clinical decision-making.
Purpose of the Study:
- To present a conceptual framework for goal-concordant prescribing in hospice care.
- To propose a measurement framework for future research on prescribing practices.
- To address the gap between patient/family preferences and clinician risk-benefit assessments.
Main Methods:
- Conducted an environmental scan of existing deprescribing and goal-ascertainment frameworks.
- Gathered feedback from hospice clinicians, interprofessional teams, and family caregivers.
- Utilized insights from a pilot project on goal-concordant prescribing.
Main Results:
- Identified theoretical and clinical gaps in current hospice medication management.
- Developed a conceptual framework to guide goal-concordant prescribing.
- Proposed a measurement framework to facilitate future research and application.
Conclusions:
- Goal-concordant prescribing is essential for patient-centered hospice care.
- The proposed frameworks aim to improve communication and align care with patient and family values.
- Further research is needed to validate and implement these frameworks in clinical practice.
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