THURSDAY, March 14, 2019 — A communication quality-improvement intervention results in better and earlier serious illness conversations, despite not improving patient outcomes, according to two studies published online March 14, one in JAMA Oncology and one in JAMA Internal Medicine.
Joanna Paladino, M.D., from Harvard Medical School in Boston, and colleagues examined the efficacy of a communication quality-improvement intervention in cancer care. Ninety-one clinicians and 278 patients were enrolled. The researchers found that 58 percent of patients died during the study, and these patients were cared for by 76 clinicians. The proportion of patients who had a documented discussion was higher among intervention versus control patients in an analysis of postmortem medical records (96 versus 79 percent). Conversations occurred a median of 2.4 months earlier in the intervention group (median, 143 versus 71 days).
Rachelle Bernacki, M.D., also from Harvard Medical School in Boston, and colleagues analyzed data from the same group of clinicians and patients to examine the impact of the intervention on patient outcomes. The researchers found that at least 87.2 percent of those who received a reminder completed at least one conversation. There was no significant between-group difference in the coprimary outcome, including goal-concordant care and peacefulness at end of life. However, the intervention group had a significant reduction in the proportion of patients with moderate-to-severe anxiety and depressive symptoms at 14 weeks after baseline.
“Oncologists should initiate conversations about serious illness with patients who have a significant risk of dying in the foreseeable future,” write the authors of an accompanying editorial. “Not because this will necessarily improve outcomes, but because patients want, require, and deserve to know what is coming.”
One author from both studies disclosed financial ties to UpToDate.
Abstract/Full Text – Paladino
Abstract/Full Text – Bernacki (subscription or payment may be required)
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Posted: March 2019