How to Ensure Medical Care Aligns With Patient Goals

A recent methodological report investigated the challenges of providing care that is consistent with patient and family preferences as indicated by advance directives; based on their findings, authors provide recommendations for improving consistency with patient preferences (J Pain Symptom Manage. 2016;52[4]:453-458).

Currently, nearly a quarter of hospitalized older Americans are unable to make end-of-life decisions for themselves. Advance care planning is designed to ensure receipt of the preferred medical care when the patient is not able to communicate his or her wishes, but barriers to the implementation of these directives still exist.

First author Kathleen T Unroe, MD, MHA, Regenstrief Institute and Indiana University (IU) Center for Aging Research Investigator (Indianapolis, IN), said, “[Our] paper delves into an issue important to both patients and providers—consistency with documented care preferences. We investigated the practicality of implementation of quality metrics to measure consistency of care with advance care planning and what barriers exist to putting these metrics into practice.”

The researchers outlined recommendations that can help improve adherence to patient wishes. They advised physicians and nurses to: document specific treatment preferences in the medical record, ie “do not place feeding tube” vs “comfort care;” record treatment preferences in a consistent format and location in the patient medical record; review and update patient preferences regularly to reflect current preferences as clinical condition changes over time; and adopt a consistent measurement approach in order to compare within and among health care providers, such as specific percentage required for agreement.

One of the coauthors, Alexia Torke, MD, Regenstrief Institute, IU Center for Aging Research and IU School of Medicine, said, “Advance care planning is a process, not just a form….It is important that when a person faces serious illness and can no longer make decisions, the care they receive is consistent with the wishes they have previously expressed.”—Amanda Del Signore