Survey-based priming intervention linked to improved communication and goals-of-care discussions amongst patient-clinician pairs

1. Goals-of-care (GOC) discussions were linked to improved patient outcomes and reduction of intensity in end-of-life care. The current study demonstrated that a survey-based intervention for priming clinicians with communication strategies was linked to increase in the occurrence, documentation, and quality of GOC discussions.

2. The current study was not able to evaluate the effect of this intervention on the quality of care provided for participating patients.

Evidence Rating Level: 2 (Good)          

Study Rundown: Communication remains one of the cornerstone principles in the foundation of medical practice. Studies have shown that improved communication during GOC discussions has been linked to improved patient outcomes and reduced intensity of end-of-life care; but few interventions have been successful in improving communication for GOC conversations. The current study sought to evaluate the “Jumpstart-Tips” intervention where prior to a clinic visit patients completed a survey to characterize their communication styles and barriers with results and recommended communication strategies forwarded to clinicians. The study showed that this intervention lead to improved rate of GOC discussion, documentation of GOC discussions, and patient reported quality of conversations.

The results are strengthened by the randomized control trial design and sizable cohort of patients and clinicians. The main limitations of the study included lack of data on effect of patient care subsequent to the intervention, and the possibility of participation bias as patients who volunteered for participation may already be more amenable to communication interventions.

Click to read the study, published in JAMA Internal Medicine

Relevant Reading: Earlier Goals of Care Discussions in Hospitalized Terminally Ill Patients and the Quality of End-of-Life Care: A Retrospective Study

In-Depth [randomized controlled trial]: This study was a cluster randomized control trial that included clinicians at 2 large healthcare systems with eligible patients. Eligible patients were included if they were 18 years or older, had 2 or more clinic visits in the preceding 18 months, and had 1 or more qualifying conditions (including severe or end stage cancer, heart failure, lung disease, cirrhosis, advanced age, or multiple comorbidities). The Jumpstart-Tips intervention included a survey filled out by patients to characterize communication preferences, barriers, and facilitators, with results and suggested strategies then provided to the clinician prior to a clinic visit. Control patients completed the survey but results were not shared with clinicians.

Compared to the control group patients, participants in the intervention group experienced increased frequency of GOC discussions (74%vs 31%; p < 0.001) and documentation of discussions (62%vs 17%; p < 0.001), and improved quality of communication (4.6 vs 2.1; p = 0.01).

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