Exploring Patients' Experience with Clinicians Who Recognize Their Unmet Palliative Needs: An Inpatient Study

Abstract

Background: Given the national shortage of palliative care specialists relative to the need for their services, engaging nonspecialists is important to ensure patients with serious illness have an opportunity to share their goals and values with their providers. Hospital medicine clinicians are well positioned to conduct these conversations given they care for many medically complex patients. Yet, little is known about the patient experience of inpatient goals and values conversations led by hospitalist teams. Objective: To assess patients' experience and perception of the quality of goals and values conversations. Design/Setting/Participation: Single center, tertiary care, nonrandomized, two group cohort trial of patients hospitalized on general medical inpatient units staffed by hospital medicine clinicians previously trained to conduct serious illness conversations. Intervention: An automated screening tool was used to identify patients at increased risk for unmet palliative needs. The multidisciplinary team was informed of the screen's results on the intervention units but not on the control units. Intervention unit clinicians were asked to consider talking with patients about their goals and values. Results: One hundred thirty patients participated in the study. The intervention patients reported improved quality of communication and fewer anxiety and depression symptoms compared with the control patients. Hospice utilization in addition to emergency department visits and hospital readmissions did not differ between the two groups. Conclusion: This study suggests that informing the care team regarding their patients' potential unmet palliative care needs is associated with patients reporting improved experience of their care without adverse effects on their mood.

Patient Identification for Serious Illness Conversations: A Scoping Review

“…Additionally, it takes time and (human) resources to support such systems [ 35 ]. Another potential issue was the efficacy and reliability of EHR/EMR algorithmic triggers, as some have not undergone formal validation and may therefore under- (or over-) identify patients for serious illness conversations [ 32 , 33 ].…”

“…Ratings attest to the fact that many things matter to patients; however, rankings can better determine what matters most. Gace et al (2020) ‡‡ [ 32 ] U.S. To assess patients’ experience and perception of the quality of goals and values conversations. Two group cohort trial.…”

Adapting the serious illness conversation guide for use in the emergency department by social workers

“…In this focused effort to adapt the Serious Illness Conversation Guide, we undertook a structured four-phase approach to adapting a tool that has been widely used to guide conversations about goals and values in primary care (Lakin et al, 2016, 2017), inpatient general medicine (Rosenberg et al, 2017; Gace et al, 2020), emergency surgery (Cauley et al, 2016; Cooper et al, 2016), inpatient and outpatient oncology (Bernacki et al, 2015b, 2019), long-term acute care (Lamas et al, 2017a, 2017b), and in patients with renal failure (Mandel et al, 2017).…”

“…The original Serious Illness Conversation Guide was designed for use upstream for advance care planning, when patients are feeling well, and was not initially intended for use when patients are acutely ill, as in the ED. It is, however, open-source and intended for adaptation as has been the case in other care settings (Bernacki et al, 2015b, 2019; Cauley et al, 2016; Cooper et al, 2016; Lakin et al, 2016, 2017; Lamas et al, 2017a, 2017b; Mandel et al, 2017; Rosenberg et al, 2017; Gace et al, 2020).…”