Communication about serious illness care goals: a review and synthesis of best practices.

@article{Bernacki2014CommunicationAS,
  title={Communication about serious illness care goals: a review and synthesis of best practices.},
  author={Rachelle E. Bernacki and Susan Dale Block},
  journal={JAMA internal medicine},
  year={2014},
  volume={174 12},
  pages={
          1994-2003
        }
}
An understanding of patients' care goals in the context of a serious illness is an essential element of high-quality care, allowing clinicians to align the care provided with what is most important to the patient. [] Key Result Best practices in discussing goals of care include the following: sharing prognostic information, eliciting decision-making preferences, understanding fears and goals, exploring views on trade-offs and impaired function, and wishes for family involvement.
View on PubMed
acponline.org
742 Citations
Highly Influential Citations
17
Background Citations
116
Methods Citations
14
Results Citations
5

742 Citations

Citation Type

Citation Type

Improving Communication About Serious Illness in Primary Care: A Review.
TLDR
Clinician and system barriers will challenge primary care clinicians and institutions to meet the needs of patients with serious illness and Ensuring that conversations about goals and values occur at the appropriate time for seriously ill patients will require improved training, validation, and dissemination.
A Systematic Intervention To Improve Serious Illness Communication In Primary Care.
TLDR
Patients in the clinics with the Serious Illness Care Program implemented were more likely than those in comparison clinics to have serious illness conversations-including discussion of values and goals-documented in patients' medical records.
Implementing the Serious Illness Care Program in Primary Care.
TLDR
The Johns Hopkins Nursing Evidence-Based Practice model and Serious Illness Care Program were used to address provider and system barriers to conversations about care preferences and provider perceptions of conversations after implementation were positive.
Communication Interventions to Improve Goal-Concordant Care of Seriously Ill Patients: An Integrative Review.
  • F. Bennett, Susan OʼConner-Von
  • Medicine, Psychology
    Journal of hospice and palliative nursing : JHPN : the official journal of the Hospice and Palliative Nurses Association
  • 2019
TLDR
Because nurses are a critical, trusted nexus for communication about end-of-life care, focusing on nurse interventions may significantly improve clinical outcomes and the patient experience.
Early serious illness communication in hospitalized patients: A study of the implementation of the Speaking About Goals and Expectations (SAGE) program.
Older Patients’ Perspectives on Quality of Serious Illness Care in Primary Care
TLDR
Efforts to improve quality measurement and implementation of quality improvement initiatives in serious illness care should consider these aspects of care that patients deem important, particularly communication as an overarching priority.
Goals of Care Conversations in Serious Illness: A Practical Guide.
Patient Perspectives on Serious Illness Conversations in Primary Care.
TLDR
Patients appreciate having serious illness conversations in the primary care setting, and clinicians should orchestrate the experience of the conversation, from preparation through follow-up.
A Research Agenda for Communication Between Health Care Professionals and Patients Living With Serious Illness
TLDR
The findings highlight the urgent need to improve quality of communication between health care professionals and patients living with serious illness through a broad range of research that covers communication skills, tools, patient education, and models of care.
Evaluating an Intervention to Improve Communication Between Oncology Clinicians and Patients With Life-Limiting Cancer: A Cluster Randomized Clinical Trial of the Serious Illness Care Program.
TLDR
This cluster randomized clinical trial in outpatient oncology was conducted at the Dana-Farber Cancer Institute and included physicians, advanced-practice clinicians, and patients with cancer who were at high risk of death to demonstrate improvement in all 4 of these outcomes.
...
1
2
3
4
5
...

References

SHOWING 1-10 OF 109 REFERENCES
Increased access to palliative care and hospice services: opportunities to improve value in health care.
  • D. Meier
  • Medicine, Political Science
    The Milbank quarterly
  • 2011
TLDR
By helping patients get the care they need to avoid unnecessary emergency department and hospital stays and shifting the locus of care to the home or community, palliative care and hospice reduce health care spending for America's sickest and most costly patient populations.
Perspectives on care at the close of life. Initiating end-of-life discussions with seriously ill patients: addressing the "elephant in the room".
TLDR
Starting end-of-life discussions earlier and more systematically could allow patients to make more informed choices, achieve better palliation of symptoms, and have more opportunity to work on issues of life closure.
Dying patients' need for emotional support and personalized care from physicians: perspectives of patients with terminal illness, families, and health care providers.
Factors considered important at the end of life by patients, family, physicians, and other care providers.
TLDR
Although pain and symptom management, communication with one's physician, preparation for death, and the opportunity to achieve a sense of completion are important to most, other factors important to quality at the end of life differ by role and by individual.
I'm Not Ready for Hospice: Strategies for Timely and Effective Hospice Discussions
TLDR
This article describes approaches to hospice discussions using 3 different scenarios: a patient with a limited life expectancy who still wants aggressive treatment, a patient whose goals are consistent with hospice but who has an uncertain life expectancy, and a patient for whom hospice appears to be the best option on the basis of both prognosis and patient goals.
End-of-life discussions, goal attainment, and distress at the end of life: predictors and outcomes of receipt of care consistent with preferences.
TLDR
Patients with cancer are more likely to receive Eol care that is consistent with their preferences when they have had the opportunity to discuss their wishes for EOL care with a physician.
End-of-life conversations: evolving practice and theory.
TLDR
It is concluded that end-of-life conversations must become a routine, structured intervention in health care and that advance care planning is best viewed as one component in a series of ongoing end- of-life discussions.
Family perspectives on end-of-life care at the last place of care.
TLDR
Many people dying in institutions have unmet needs for symptom amelioration, physician communication, emotional support, and being treated with respect, according to this evaluation of the US dying experience at home and in institutional settings.
Late referrals to palliative care.
  • B. Ferrell
  • Medicine
    Journal of clinical oncology : official journal of the American Society of Clinical Oncology
  • 2005
TLDR
The regression analysis reported by the authors revealed independent determinants of family perception of late referrals, which included family belief before admission that palliative care shortens the patient’s life, insufficient advance discussion about end-of-life care, and families’ perception of insufficient preparation for the changes in the patient's condition.
Evidence for Improving Palliative Care at the End of Life A Systematic Review
TLDR
This report focused on cancer, chronic heart failure, and dementia to illustrate differences in patient and caregiver experiences in the 3 characteristic trajectories of clinical and functional decline as they approach the end of life.
...
1
2
3
4
5
...