Goals-of-care discussions

Saiki, Catherine; Ferrell, Betty; Longo-Schoeberlein, Denise; Chung, Vincent; Smith, Thomas J.

doi:10.12788/jcso.0355

Cited by 10 publications

(11 citation statements)

References 28 publications

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“…These data build on efforts to initiate hospice introductory discussions and visits earlier on in care. 25 Results align with suggestions that enrolling in hospice is a process more than an isolated decision 26 and that the end of cancer treatment may be a turning point in hospice decision making. 27 Our findings further suggest potential benefits of refining supportive interventions to align with or target the ways in which communication shifts for patients and families and their clinicians in concert with patient health status.…”

Section: Discussionsupporting

confidence: 59%

Nature of Discussions about Systemic Therapy Discontinuation or Hospice among Patients, Families, and Palliative Care Clinicians during Care for Incurable Cancer: A Qualitative Study

Traeger

Rapoport

Wright

et al. 2020

Journal of Palliative Medicine

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Background: Patient/clinician communication is critical to quality cancer care at the end-of-life (EOL). Yet discussions about systemic therapy discontinuation or hospice as a care option are commonly deferred. Realtime communication about these complex topics has not been evaluated. Palliative care visits may provide useful insight into how communication about EOL care occurs over time. Objective: To explore the nature of discussions about systemic therapy discontinuation and hospice among patients, families, and palliative care clinicians during care for incurable cancer. Design: Qualitative study of palliative care visits. Setting/Subjects: We audiorecorded visits of patients and families who participated in a palliative care trial from diagnosis of incurable lung or noncolorectal gastrointestinal cancer through the course of cancer care (n = 30). Measurements: We used thematic analysis to characterize communication patterns in the context of clinical events. Results: Content and tenor of discussions shifted in relation to patient health status. In the absence of acute medical deterioration, discussions addressed hospice broadly as an EOL care option. Candid exchanges between patients and families and their clinicians supported increasing depth and specificity of EOL care communication. As clinicians identified that patients were not tolerating treatment, the clinicians encouraged contemplation about quality-of-life implications of continuing treatment or the possibility that treatment might harm more than help, in anticipation of change in health status. Conclusions: Longitudinal relationships with palliative care clinicians functioned through multiple pathways to support patients and families in making complex EOL care decisions. Results inform models and interventions of communication at the EOL.

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Section: Discussionsupporting

confidence: 59%

Nature of Discussions about Systemic Therapy Discontinuation or Hospice among Patients, Families, and Palliative Care Clinicians during Care for Incurable Cancer: A Qualitative Study

Traeger

Rapoport

Wright

et al. 2020

Journal of Palliative Medicine

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“…The literature has mentioned that caregivers tend to experience caregiver burden when others do not share their caregiving work and family members do not cooperate and support them [36]. Researchers mentioned that caregiver burden occurs when physiological, psychological, emotional, social, and financial problems occur while caring for disabled family members [37]. When caregiver burden is greater than care in caregivers, the emotional connection will gradually disappear and caregiving will bring out many changes and stress in life [38].…”

Section: Discussionmentioning

confidence: 99%

Does the Experience of Caring for a Severely Disabled Relative Impact Advance Care Planning? A Qualitative Study of Caregivers of Disabled Patients

Chiang

Hsieh

Fan

et al. 2020

IJERPH

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The aging of the Taiwanese population has become a major issue. Previous research has focused on the burden and stress faced by caregivers, but has not explored how the experience of these caregivers influences decisions of advance care planning (ACP). Semi-structured and in-depth interviews were conducted. Qualitative content analysis was used to identify important themes. Five themes and fourteen sub-themes were identified: (1) Past experiences: patient wishes, professional recommendations, and expectation about disease progress; (2) Impact of care on family members: positive affirmation, open-minded life, social isolation and health effects, and financial and life planning effects; (3) Attitude toward life: not forcing to stay, and not becoming a burden, (4) Expected proxy dilemmas: torment between doing or not, seeing the extension of suffering and toil, and remorse and self-blame; (5) Expectation of end of life (EOL) care: caregiver’s experience and EOL care decisions, and practicality of EOL decision making. After making multiple medical decisions for their disabled relatives, caregivers are able to calmly face their own medical decisions, and “not becoming a burden” is their primary consideration. It’s suggested that implementation of shared decision-making on medical care for patients with chronic disability will not only improve the quality of their medical care but also reduce the development of remorse and guilty feelings of caregivers after making medical decisions.

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“…Structured documentation templates in the EMR have been suggested as a tool to increase the rate of documentation. 21,22 Such templates can function as a checklist to remind clinicians about the necessary components of the clinical note to ensure that billing for ACP is successful. Qualified health care providers such as physicians, PAs, and ARNPs should also confirm with their billing staff that their fee schedule includes codes 99497 and 99498.…”

Section: Discussionmentioning

confidence: 99%

Use of Advance Care Planning Billing Codes in a Tertiary Care Center Setting

et al. 2019

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Introduction: The Centers for Medicare and Medicaid Services released the final payment rules for reimbursement of advance care planning (ACP) effective January 2016. In its first year, 23,000 providers nationwide submitted 624,000 claims using the Current Procedural Terminology codes 99497 and 99498. The objectives of our study were to 1) assess the frequency of ACP codes used at a single academic tertiary care center in Iowa, 2) determine when and by whom the codes were used, and 3) summarize ACP clinical notes. Methods: Using the electronic medical record data warehouse from a single tertiary teaching hospital and affiliated clinics, date of service, department where service was provided, provider name and type, patient medical record number, date of birth, and gender linked to the ACP codes 99497 and 99498 were collected. The content of ACP clinical notes were reviewed and summarized. Study period was from January 1, 2016 through September 19, 2018. Results: During the 33 months, code 99497 was used 17 times and code 99498 was never used. Code 99497 was successfully reimbursed 4 times. Discussion: Charges were not reimbursed if the ACP visits did not meet the minimum time requirement or were conducted by an individual not considered a qualified health care professional per Medicare rules. Conclusion: ACP codes 99497 and 99498 were very rarely used at this tertiary care center during the initial 33-months after the Medicare rules went into effect. Interventions are needed to promote the use of ACP codes, so the time spent in important ACP discussions are properly compensated. (J Am Board Fam Med 2019;32:827-834.

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Goals-of-care discussions

Cited by 10 publications

References 28 publications

Nature of Discussions about Systemic Therapy Discontinuation or Hospice among Patients, Families, and Palliative Care Clinicians during Care for Incurable Cancer: A Qualitative Study

Nature of Discussions about Systemic Therapy Discontinuation or Hospice among Patients, Families, and Palliative Care Clinicians during Care for Incurable Cancer: A Qualitative Study

Does the Experience of Caring for a Severely Disabled Relative Impact Advance Care Planning? A Qualitative Study of Caregivers of Disabled Patients

Use of Advance Care Planning Billing Codes in a Tertiary Care Center Setting

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