Effect of a person‐centred goals‐of‐care form and clinical communication training on shared decision‐making and outcomes in an acute hospital: a prospective longitudinal interventional study

Abstract

AbstractBackgroundPatients with a life‐limiting illness (LLI) requiring hospitalisation have a high likelihood of deterioration and 12‐month mortality. To avoid non‐aligned care, we need to understand our patients' goals and values.AimTo describe the association between the implementation of a shared decision‐making (SDM) programme and documentation of goals of care (GoC) for hospitalised patients with LLI.MethodsA prospective longitudinal interventional study of patients admitted to acute general medicine wards in an Australian tertiary hospital over 5 years was conducted. A SDM programme with a new GoC form, communication training and clinical support was implemented. The primary outcome was the proportion of patients with a documented person‐centred GoC discussion (PCD). Clinical outcomes included hospital utilisation and 90‐day mortality.Results1343 patients were included. The proportion of patients with PCDs increased from 0% to 35.4% (adjusted odds ratio (aOR), 2.38; 95% confidence interval (CI), 2.01–2.82; P < 0.001). During this time, median hospital length of stay decreased from 8 days (interquartile range (IQR), 4–14) to 6 days (IQR, 3–11) (adjusted estimate effect, −0.38; 95% CI, −0.64 to −0.11; P = 0.005) and rapid response team activation from 28% to 13% (aOR, 0.87; 95% CI, 0.78–0.97; P value = 0.01). Documented treatment preference of high‐dependency unit care decreased from 39.7% to 24.4% (aOR, 0.81; 95% CI, 0.73–0.89; P value < 0.001), and ward‐based care increased from 31.9% to 55.1% (aOR, 1.24; 95% CI, 1.14–1.36; P value < 0.001).ConclusionThe implementation of a SDM programme was associated with increased documentation of person‐centred GoC, changed patient treatment preference to lower intensity care and reduced hospital utilisation.