Effect of a disease-specific planning intervention on surrogate understanding of patient goals for future medical treatment.
OBJECTIVE
To determine whether a disease-specific planning process can improve surrogate understanding of goals of patients with life-limiting illnesses for future medical treatments.


METHODS
A multisite randomized controlled trial conducted between January 1, 2004 and July 31, 2007.


METHODS
Six outpatient clinics of large community or university health systems in three Wisconsin cities.


METHODS
Competent, English-speaking adults aged 18 and older with chronic congestive heart failure or chronic renal disease and their surrogate decision-makers.


METHODS
Trained health professionals conducted a structured, patient-centered interview intended to promote informed decision-making and to result in the completion of a document clarifying the goals of the patient with regard to four disease-specific health outcome situations and the degree of decision-making latitude granted to the surrogate.


METHODS
Surrogate understanding of patient goals for care with regard to four expected, disease-specific outcomes situations and of the degree of surrogate latitude in decision-making.


RESULTS
Three hundred thirteen patient-surrogate pairs completed the study. As measured according to kappa scores and in all four situations and in the degree of latitude, intervention group surrogates demonstrated a significantly higher degree of understanding of patient goals than control group surrogates. Intervention group kappa scores ranged from 0.61 to 0.78, whereas control group kappa scores ranged from 0.07 to 0.28.


CONCLUSIONS
Surrogates in the intervention group had a significantly better understanding of patient goals and preferences than surrogates in the control group. This finding is the first step toward ensuring that patient goals for care are known and honored.
Kirchhoff
Karin T
KT
School of Nursing, University of Wisconsin at Madison, Madison, WI, USA. ktkirchhoff@wisc.edu
Hammes
Bernard J
BJ
Kehl
Karen A
KA
Briggs
Linda A
LA
Brown
Roger L
RL
D000328:Adult; D032722:Advance Care Planning / Q000458:organization & administration*; D000368:Aged; D000369:Aged, 80 and over; D032882:Comprehension; D003657:Decision Making; D005260:Female; D006040:Goals; D006333:Heart Failure / Q000523:psychology / Q000628:therapy*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000523:psychology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D057240:Patient Preference; D018802:Patient-Centered Care; D019727:Proxy / Q000523:psychology*; D012959:Socioeconomic Factors; D013727:Terminal Care