RPD211 - Concordance Between Patient Goals of Care and Hospice Team Perceptions at Admission: A Prospective Study

Key Message : This prospective study found that hospice team members often overestimate patients’ preference for life-prolonging care at enrollment. Structured tools and interdisciplinary communication may improve alignment, but routine reassessment after initial engagement is essential to ensure that care remains concordant with evolving patient goals.

Abstract:

Background: Aligning medical care with patient goals is a core principle of high-quality palliative care.1,2 However, little is known about real-time concordance between patient-stated goals of care (GOC) and interdisciplinary team perceptions at the point of hospice enrollment.3

Objectives: To evaluate GOC alignment between patients with advanced cancer and home hospice providers using a validated visual analogue scale (VAS).

Methods: In this prospective, cross-sectional study, patients with advanced solid tumors referred to a national home hospice program in Israel completed a VAS assessing their preference along a continuum from prioritizing quality of life to length of life. Independently, their assigned hospice physician, nurse, and social worker each completed the same VAS indicating their perception of the patient’s preference. Concordance was defined as a ≤40-point difference between patient and staff responses. Referral documentation was analyzed for stated goals or rationale for hospice referral. Survival data were also collected.

Results: Among 53 patients who completed the survey, 37 (69.8%) prioritized quality of life. Concordance rates were 52.0% for physicians, 56.0% for nurses, and 59.0% for social workers. Discordance was predominantly in the direction of staff overestimating patients’ preference for life-prolonging care. Referral documentation infrequently included explicit GOC or rationale for hospice referral.

Conclusion: Discordance between patient-stated goals of care and hospice team perceptions at enrollment is common, often reflecting overestimation of patients’ desire for life-extending treatment. While structured assessment tools and interdisciplinary communication are critical, our findings suggest GOC assessments at admission may not fully capture stable patient preferences. Routine reassessment after initial engagement may enhance goal-concordant care.

References: Bernacki RE, Block SD; American College of Physicians High Value Care Task Force. Communication about serious illness care goals: a review and synthesis of best practices. JAMA Intern Med. 2014 Dec;174(12):1994-2003. doi: 10.1001/jamainternmed.2014.5271. PMID: 25330167.
Bischoff KE, Sudore R, Miao Y, Boscardin WJ, Smith AK. Advance care planning and the quality of end-of-life care in older adults. J Am Geriatr Soc. 2013 Feb;61(2):209-14. doi: 10.1111/jgs.12105. Epub 2013 Jan 25. PMID: 23350921; PMCID: PMC3760679.
Modes ME, Heckbert SR, Engelberg RA, Nielsen EL, Curtis JR, Kross EK. Patient-Reported Receipt of Goal-Concordant Care Among Seriously Ill Outpatients-Prevalence and Associated Factors. J Pain Symptom Manage. 2020;60(4):765-773. doi:10.1016/j.jpainsymman.2020.04.026