Effect of conversations about values and goals on anxiety in patients.

Abstract

9 Background: Patients with serious illness routinely receive treatments that do not align with their goals. Earlier clinical conversations about patients’ values and priorities lead to more goal-concordant care and improved quality of life, but clinician concerns about harming patients and taking away hope are barriers to appropriately timed discussions. Methods: A cluster-randomized controlled trial with oncology patients at high risk of death, identified by the surprise question. The intervention included a structured, patient-centered discussion about values and priorities conducted by trained oncology clinicians using the Serious Illness Conversation Guide. Patient anxiety (GAD-7) was measured by survey at baseline and every 2 months; anxiety, patient acceptability, and patient-reported behavior change were measured by survey 1 week after the intervention and at a matching time point for controls. Results: 342 patients enrolled (median age 62y): 176 intervention; 166 control. 102 conversations were completed in the intervention group. The mean anxiety (GAD-7) score prior to the intervention in the intervention group was 3.75 and in the control group was 3.80 (p = 0.72). However, a week after the intervention conversation (on average, the conversation was 10.4 weeks from baseline, IQR 3-13 weeks), there were significant differences. At 11.4 weeks, the intervention anxiety mean was 2.87, and the control mean was 4.26 (p = 0.011). Reductions persisted for 2 months after the conversation. Among patients who had the serious illness conversation and completed the acceptability survey: 86% reported that the conversation was worthwhile; 66% reported positive behavior changes as a result of the discussion; more than 80% reported that their hopefulness, peacefulness, and sense of control over medical decisions increased or did not change. Conclusions: The Serious Illness conversation lowered patient anxiety; this reduction was sustained for at least 2 months after the conversation. Patients viewed the serious illness conversation as worthwhile and reported enacting concrete positive behavior changes as a result of the discussion. Clinical trial information: NCT01786811.