Goal Communication in Palliative Care Decision-Making Consultations

Abstract

Context: Palliative care (PC) promotes patient-centered outcomes, but the mechanisms underlying these effects remain poorly understood. Identifying, clarifying, and prioritizing patients' goals are conceptually fundamental to the process of patient-centeredness and are the main reasons for PC referral. However, very little is empirically known about the content or process of goal expression in the natural setting of PC.

Objectives: To describe the frequency, types, and determinants of goal expression in PC consultations.

Methods: This was a cross-sectional direct observational study of 72 audiorecorded PC consultations with hospitalized patients (and families) referred for PC goals of care clarification or end-of-life decision making. We coded digital audio files using reliable methods and linked conversation codes to clinical record and brief clinician interview data.

Results: Goal expressions occurred frequently in PC consultations and addressed both length-of-life and quality-of-life domains. The presence of existential suffering in the conversation was associated with substantially more expressions and types of goals.

Conclusion: Goal communication is common in PC decision-making settings and strongly influenced by existential suffering.

Keywords: Goals; communication; decision making; existential; palliative care.