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A patient-centered approach to advance medical planning in the nursing home
M Gillick1, S Berkman, L Cullen
1Hebrew Rehabilitation Center for Aged, Boston, Massachusetts 02131, USA.
Objective:
The objective of this study is to determine whether nursing home residents or their surrogates are willing and able to prioritize their goals for care and to demonstrate how these rankings can form the basis of a specific pattern of medical care.
Design:
A prospective, descriptive study.
Setting:
A 40-bed nursing unit for residents with mild to moderate impairments in a 725-bed teaching nursing home.
Results:
Overall, 78% of patients or their families were willing to prioritize their goals, allowing the investigators to infer a pattern of care. The goals were interpreted as implying an intensive pattern in 21%, a comprehensive pattern in 16%, a basic pattern in 18%, palliation in 18%, and comfort only in 6% of residents. Goals chosen by residents who were able to select for themselves translated into more aggressive care than did the goals selected by surrogates.
Conclusion:
Goal-centered advance medical planning can be initiated in nursing homes by asking residents or their surrogates to prioritize their goals of care. These prioritizations can form the foundation for specific patterns of care.