title: What really matters in end-of-life discussions? Perspectives of patients in hospital with serious illness and their families.
abstract: BACKGROUND
  The guideline-recommended elements to include in discussions about goals of care with patients with serious illness are mostly based on expert opinion. We sought to identify which elements are most important to patients and their families.
  
  
  METHODS
  We used a cross-sectional study design involving patients from 9 Canadian hospitals. We asked older adult patients with serious illness and their family members about the occurrence and importance of 11 guideline-recommended elements of goals-of-care discussions. In addition, we assessed concordance between prescribed goals of care and patient preferences, and we measured patient satisfaction with goals-of-care discussions using the Canadian Health Care Evaluation Project (CANHELP) questionnaire.
  
  
  RESULTS
  Our study participants included 233 patients (mean age 81.2 yr) and 205 family members (mean age 60.2 yr). Participants reported that clinical teams had addressed individual elements of goals-of-care discussions infrequently (range 1.4%-31.7%). Patients and family members identified the same 5 elements as being the most important to address: preferences for care in the event of life-threatening illness, values, prognosis, fears or concerns, and questions about goals of care. Addressing more elements was associated with both greater concordance between patients' preferences and prescribed goals of care, and greater patient satisfaction.
  
  
  CONCLUSIONS
  We identified elements of goals-of-care discussions that are most important to older adult patients in hospital with serious illness and their family members. We found that guideline-recommended elements of goals-of-care discussions are not often addressed by health care providers. Our results can inform interventions to improve the determination of goals of care in the hospital setting.
authors.affiliation: Departments of Medicine, Clinical Epidemiology and Biostatistics (You), McMaster University, Hamilton, Ont.; Division of Critical Care Medicine (Dodek), St. Paul's Hospital; Center for Health Evaluation and Outcome Sciences (Dodek), University of British Columbia, Vancouver, BC; Centre de Recherche Clinique Hôpital Universitaire de Sherbrooke (Lamontagne), Université de Sherbrooke, Sherbrooke, Qué.; Divisions of Critical Care and Palliative Care (Downar), Department of Medicine, University of Toronto; Department of Critical Care Medicine and Sunnybrook Research Institute (Sinuff), Sunnybrook Health Sciences Centre; Interdepartmental Division of Critical Care Medicine (Sinuff), University of Toronto, Toronto, Ont.; Clinical Evaluation Research Unit, Department of Medicine (Jiang, Day, Heyland), Kingston General Hospital, Kingston, Ont.; Department of Community Health and Epidemiology (Heyland), Queen's University, Kingston, Ont. jyou@mcmaster.ca.
authors.forename: John J
authors.initials: JJ
authors.lastname: You
authors.affiliation: Departments of Medicine, Clinical Epidemiology and Biostatistics (You), McMaster University, Hamilton, Ont.; Division of Critical Care Medicine (Dodek), St. Paul's Hospital; Center for Health Evaluation and Outcome Sciences (Dodek), University of British Columbia, Vancouver, BC; Centre de Recherche Clinique Hôpital Universitaire de Sherbrooke (Lamontagne), Université de Sherbrooke, Sherbrooke, Qué.; Divisions of Critical Care and Palliative Care (Downar), Department of Medicine, University of Toronto; Department of Critical Care Medicine and Sunnybrook Research Institute (Sinuff), Sunnybrook Health Sciences Centre; Interdepartmental Division of Critical Care Medicine (Sinuff), University of Toronto, Toronto, Ont.; Clinical Evaluation Research Unit, Department of Medicine (Jiang, Day, Heyland), Kingston General Hospital, Kingston, Ont.; Department of Community Health and Epidemiology (Heyland), Queen's University, Kingston, Ont.
authors.forename: Peter
authors.initials: P
authors.lastname: Dodek
authors.affiliation: Departments of Medicine, Clinical Epidemiology and Biostatistics (You), McMaster University, Hamilton, Ont.; Division of Critical Care Medicine (Dodek), St. Paul's Hospital; Center for Health Evaluation and Outcome Sciences (Dodek), University of British Columbia, Vancouver, BC; Centre de Recherche Clinique Hôpital Universitaire de Sherbrooke (Lamontagne), Université de Sherbrooke, Sherbrooke, Qué.; Divisions of Critical Care and Palliative Care (Downar), Department of Medicine, University of Toronto; Department of Critical Care Medicine and Sunnybrook Research Institute (Sinuff), Sunnybrook Health Sciences Centre; Interdepartmental Division of Critical Care Medicine (Sinuff), University of Toronto, Toronto, Ont.; Clinical Evaluation Research Unit, Department of Medicine (Jiang, Day, Heyland), Kingston General Hospital, Kingston, Ont.; Department of Community Health and Epidemiology (Heyland), Queen's University, Kingston, Ont.
authors.forename: Francois
authors.initials: F
authors.lastname: Lamontagne
authors.affiliation: Departments of Medicine, Clinical Epidemiology and Biostatistics (You), McMaster University, Hamilton, Ont.; Division of Critical Care Medicine (Dodek), St. Paul's Hospital; Center for Health Evaluation and Outcome Sciences (Dodek), University of British Columbia, Vancouver, BC; Centre de Recherche Clinique Hôpital Universitaire de Sherbrooke (Lamontagne), Université de Sherbrooke, Sherbrooke, Qué.; Divisions of Critical Care and Palliative Care (Downar), Department of Medicine, University of Toronto; Department of Critical Care Medicine and Sunnybrook Research Institute (Sinuff), Sunnybrook Health Sciences Centre; Interdepartmental Division of Critical Care Medicine (Sinuff), University of Toronto, Toronto, Ont.; Clinical Evaluation Research Unit, Department of Medicine (Jiang, Day, Heyland), Kingston General Hospital, Kingston, Ont.; Department of Community Health and Epidemiology (Heyland), Queen's University, Kingston, Ont.
authors.forename: James
authors.initials: J
authors.lastname: Downar
authors.affiliation: Departments of Medicine, Clinical Epidemiology and Biostatistics (You), McMaster University, Hamilton, Ont.; Division of Critical Care Medicine (Dodek), St. Paul's Hospital; Center for Health Evaluation and Outcome Sciences (Dodek), University of British Columbia, Vancouver, BC; Centre de Recherche Clinique Hôpital Universitaire de Sherbrooke (Lamontagne), Université de Sherbrooke, Sherbrooke, Qué.; Divisions of Critical Care and Palliative Care (Downar), Department of Medicine, University of Toronto; Department of Critical Care Medicine and Sunnybrook Research Institute (Sinuff), Sunnybrook Health Sciences Centre; Interdepartmental Division of Critical Care Medicine (Sinuff), University of Toronto, Toronto, Ont.; Clinical Evaluation Research Unit, Department of Medicine (Jiang, Day, Heyland), Kingston General Hospital, Kingston, Ont.; Department of Community Health and Epidemiology (Heyland), Queen's University, Kingston, Ont.
authors.forename: Tasnim
authors.initials: T
authors.lastname: Sinuff
authors.affiliation: Departments of Medicine, Clinical Epidemiology and Biostatistics (You), McMaster University, Hamilton, Ont.; Division of Critical Care Medicine (Dodek), St. Paul's Hospital; Center for Health Evaluation and Outcome Sciences (Dodek), University of British Columbia, Vancouver, BC; Centre de Recherche Clinique Hôpital Universitaire de Sherbrooke (Lamontagne), Université de Sherbrooke, Sherbrooke, Qué.; Divisions of Critical Care and Palliative Care (Downar), Department of Medicine, University of Toronto; Department of Critical Care Medicine and Sunnybrook Research Institute (Sinuff), Sunnybrook Health Sciences Centre; Interdepartmental Division of Critical Care Medicine (Sinuff), University of Toronto, Toronto, Ont.; Clinical Evaluation Research Unit, Department of Medicine (Jiang, Day, Heyland), Kingston General Hospital, Kingston, Ont.; Department of Community Health and Epidemiology (Heyland), Queen's University, Kingston, Ont.
authors.forename: Xuran
authors.initials: X
authors.lastname: Jiang
authors.affiliation: Departments of Medicine, Clinical Epidemiology and Biostatistics (You), McMaster University, Hamilton, Ont.; Division of Critical Care Medicine (Dodek), St. Paul's Hospital; Center for Health Evaluation and Outcome Sciences (Dodek), University of British Columbia, Vancouver, BC; Centre de Recherche Clinique Hôpital Universitaire de Sherbrooke (Lamontagne), Université de Sherbrooke, Sherbrooke, Qué.; Divisions of Critical Care and Palliative Care (Downar), Department of Medicine, University of Toronto; Department of Critical Care Medicine and Sunnybrook Research Institute (Sinuff), Sunnybrook Health Sciences Centre; Interdepartmental Division of Critical Care Medicine (Sinuff), University of Toronto, Toronto, Ont.; Clinical Evaluation Research Unit, Department of Medicine (Jiang, Day, Heyland), Kingston General Hospital, Kingston, Ont.; Department of Community Health and Epidemiology (Heyland), Queen's University, Kingston, Ont.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Day
authors.affiliation: Departments of Medicine, Clinical Epidemiology and Biostatistics (You), McMaster University, Hamilton, Ont.; Division of Critical Care Medicine (Dodek), St. Paul's Hospital; Center for Health Evaluation and Outcome Sciences (Dodek), University of British Columbia, Vancouver, BC; Centre de Recherche Clinique Hôpital Universitaire de Sherbrooke (Lamontagne), Université de Sherbrooke, Sherbrooke, Qué.; Divisions of Critical Care and Palliative Care (Downar), Department of Medicine, University of Toronto; Department of Critical Care Medicine and Sunnybrook Research Institute (Sinuff), Sunnybrook Health Sciences Centre; Interdepartmental Division of Critical Care Medicine (Sinuff), University of Toronto, Toronto, Ont.; Clinical Evaluation Research Unit, Department of Medicine (Jiang, Day, Heyland), Kingston General Hospital, Kingston, Ont.; Department of Community Health and Epidemiology (Heyland), Queen's University, Kingston, Ont.
authors.forename: Daren K
authors.initials: DK
authors.lastname: Heyland
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001290:Attitude; D003430:Cross-Sectional Studies; D005190:Family / Q000523:psychology*; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D057240:Patient Preference; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013727:Terminal Care