Goals of care communication and higher-value care for patients with advanced-stage cancer: A systematic review of the evidence |
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| Affiliation: | 1. Indiana University School of Medicine, 473 Barnhill Drive, Indianapolis, IN 46202, USA;2. Indiana University Simon Cancer Center, 473 Barnhill Drive, Indianapolis, IN 46202, USA;3. Regenstrief Institute, 473 Barnhill Drive, Indianapolis, IN 46202, USA;4. Indiana University Purdue University at Indianapolis (IUPUI), 473 Barnhill Drive, Indianapolis, IN 46202, USA;5. Indiana University Health, 473 Barnhill Drive, Indianapolis, IN 46202, USA;6. Indiana University Medical Library, 473 Barnhill Drive, Indianapolis, IN 46202, USA;1. School of Health Professions Education, Maastricht University, Maastricht, the Netherlands;2. School for Public Health and Primary Care CAPHRI, Maastricht University, Maastricht, the Netherlands;3. Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Centre, Heerlen/Geleen , the Netherlands;1. Patient Education and Counseling, Oslo, Norway;2. Department of Communication, Texas A&M University, College Station, TX, United States;1. Department of Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway;2. Centre of Medical Ethics, University of Oslo, Oslo, Norway;1. Department of Family Medicine, Division of community health, Faculty of health sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel;2. Department of Counseling and Human Development, Haifa University, Israel |
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| Abstract: | ContextGoals-of-care communication (GOCC) is recommended to increase the value of cancer care near the end of life (EOL).ObjectivesConduct a systematic review of the evidence that GOCC is associated with higher-value care.MethodsWe searched PubMed, Scopus, Ovid MEDLINE, EMBASE, EMB Reviews, CINAHL, and PsycInfo from inception to July 2019. We analyzed the population,design, and results and the authors’ definitions of GOCC. Risk of bias was assessed.ResultsThirty-two articles were selected. Ten articles reported results from 8 interventions; 17 characterized participants’ perspectives; and 5 were retrospective The topics, behaviors, timing, and anticipated outcomes of GOCC varied significantly and were indistinguishable from practices such as advance care planning. GOCC typically focused on treatment outcomes rather than patients’ goals. Four of 5 interventions increased evidence of GOCC after clinician training. Only one reported improved patient outcomes.ConclusionNo consensus exists about what GOCC entails. There is limited evidence that GOCC increases the value of EOL care.Practice implicationsFuture studies should focus on how to engage patients in conversations about their personal goals and integrate their goals into care planning. Clinicians can encourage GOCC by explaining how patients’ goals influence decisions especially as treatment options become limited. |
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| Keywords: | Goals of care Communication Communication behaviors Cancer patients End of life Care goals Quality of life Physician-patient concordance Physician-patient communication Quality of care Goal-related communication |
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