Abstract
Shared decision-making at end of life (eol) requires discussions about goals of care and prioritization of length of life compared with quality of life. The purpose of the present study was to describe patient and oncologist discordance with respect to goals of care and to explore possible predictors of discordance. Patients with metastatic cancer and their oncologists completed an interview at study enrolment and every 3 months thereafter until the death of the patient or the end of the study period (15 months). All interviewees used a 100-point visual analog scale to represent their current goals of care, with quality of life (scored as 0) and survival (scored as 100) serving as anchors. Discordance was defined as an absolute difference between patient and oncologist goals of care of 40 points or more. The study enrolled 378 patients and 11 oncologists. At baseline, 24% discordance was observed, and for patients who survived, discordance was 24% at their last interview. For patients who died, discordance was 28% at the last interview before death, with discordance having been 70% at enrolment. Dissatisfaction with eol care was reported by 23% of the caregivers for patients with discordance at baseline and by 8% of the caregivers for patients who had no discordance (p = 0.049; ϕ = 0.20). The data indicate the presence of significant ongoing oncologist-patient discordance with respect to goals of care. Early use of a simple visual analog scale to assess goals of care can inform the oncologist about the patient's goals and lead to delivery of care that is aligned with patient goals.
Highlights
The need for high-quality communication and shared decision-making between oncologists and patients with respect to goals of care has been well documented[1,2,3,4,5,6] and endorsed by major health care organizations
The data indicate the presence of significant ongoing oncologist–patient discordance with respect to goals of care
Use of a simple visual analog scale to assess goals of care can inform the oncologist about the patient’s goals and lead to delivery of care that is aligned with patient goals
Summary
The need for high-quality communication and shared decision-making between oncologists and patients with respect to goals of care has been well documented[1,2,3,4,5,6] and endorsed by major health care organizations. When discussions between oncologists and patients about goals of care are held, patients are more likely to receive care that is consistent with their preferences[7,8] and to have a better quality of life near death[1,9,10,11]. A model commonly used to guide treatment (and goals of care) discussions is shared decision-making. These are the key components in shared decision-making[19,20]:. Shared decision-making at end of life (eol) requires discussions about goals of care and prioritization of length of life compared with quality of life. The purpose of the present study was to describe patient and oncologist discordance with respect to goals of care and to explore possible predictors of discordance
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