title: Goal Communication in Palliative Care Decision-Making Consultations.
abstract: BACKGROUND
  Palliative care (PC) promotes patient-centered outcomes, but the mechanisms underlying these effects remain poorly understood. Identifying, clarifying, and prioritizing patients' goals are conceptually fundamental to the process of patient-centeredness and are the main reasons for PC referral. However, very little is empirically known about the content or process of goal expression in the natural setting of PC.
  
  
  OBJECTIVE
  To describe the frequency, types, and determinants of goal expression in PC consultations.
  
  
  METHODS
  This was a cross-sectional direct observational study of 72 audiorecorded PC consultations with hospitalized patients (and families) referred for PC goals of care clarification or end-of-life decision making. We coded digital audio files using reliable methods and linked conversation codes to clinical record and brief clinician interview data.
  
  
  RESULTS
  Goal expressions occurred frequently in PC consultations and addressed both length-of-life and quality-of-life domains. The presence of existential suffering in the conversation was associated with substantially more expressions and types of goals.
  
  
  CONCLUSIONS
  Goal communication is common in PC decision-making settings and strongly influenced by existential suffering.
authors.affiliation: University of Rochester, Rochester, New York, USA. Electronic address: Robert_Gramling@URMC.Rochester.edu.
authors.forename: Robert
authors.initials: R
authors.lastname: Gramling
authors.affiliation: University of Rochester, Rochester, New York, USA.
authors.forename: Mechelle
authors.initials: M
authors.lastname: Sanders
authors.affiliation: University of Rochester, Rochester, New York, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Ladwig
authors.affiliation: University of Rochester, Rochester, New York, USA.
authors.forename: Sally A
authors.initials: SA
authors.lastname: Norton
authors.affiliation: University of Rochester, Rochester, New York, USA.
authors.forename: Ronald
authors.initials: R
authors.lastname: Epstein
authors.affiliation: Purdue University, West Lafayette, Indiana, USA.
authors.forename: Stewart C
authors.initials: SC
authors.lastname: Alexander
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D003142:Communication; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D006040:Goals; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods; D010347:Patient Care Planning; D010817:Physician-Patient Relations; D011788:Quality of Life; D013727:Terminal Care / Q000379:methods; D013997:Time Factors; D014481:United States
keywords: Goals; communication; decision making; existential; palliative care