Goals for the care of frail older adults: do caregivers and clinicians agree?
OBJECTIVE
Establishing shared treatment goals for patients may improve the quality of care by facilitating achievement of appropriate and desired outcomes. The purpose of this study was to describe types of family caregiver and physician treatment goals for frail elderly patients who had a high prevalence of cognitive impairment, and to ascertain the level of agreement between family caregivers and physicians on principal treatment goals.


METHODS
We surveyed family caregivers and physicians for 200 consecutive older adults who were initially evaluated at the outpatient geriatric assessment center of a major teaching hospital. Treatment goals for patients were measured after a comprehensive geriatric assessment.


RESULTS
Goals commonly chosen as most important by family caregivers and physicians pertained to day-to-day functioning (61 [31%] family caregivers, 81 [41%] physicians), behavior and emotional health (56 [28%] family caregivers, 50 [25%] physicians), and safety (40 [20%] family caregivers, 29 [15%] physicians). Although a substantial proportion of family caregiver and physician pairs shared at least one goal (157 [79%] of 200), agreement on presence or absence of individual categories of goals was poor (kappas from -0.19 to 0.28), and agreement on the most important goal was also poor (kappa 0.20).


CONCLUSIONS
Agreement on treatment goals between family caregivers and physicians for patients at the study site was low. These results suggest that encounters between family caregiver and physician may need improvement. Further research is needed to assess whether lack of agreement is found in other settings, persists over time, and affects achievement of goals and optimal health outcomes.
Bogardus
S T
ST
Department of Internal Medicine (Geriatrics), Yale University School of Medicine, New Haven, Connecticut 06504, USA.
Bradley
E H
EH
Williams
C S
CS
Maciejewski
P K
PK
van Doorn
C
C
Inouye
S K
SK
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000706:statistics & numerical data*; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D006040:Goals; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D010820:Physicians / Q000706:statistics & numerical data*; D012449:Safety; D012944:Social Support; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D014481:United States