Journal
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
Volume 55, Issue 2, Pages 245-+Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jpainsymman.2017.08.025
Keywords
Advance care planning; consensus; Delphi technique; outcome measures
Funding
- American Cancer Society (ACS) [19659]
- NIH [U24NR014637]
- [NIH R01AG045043]
- [PCORI-1306-01500]
- [VA HSRD 11-110-2]
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Context. Standardized outcomes that define successful advance care planning (ACP) are lacking. Objective. The objective of this study was to create an Organizing Framework of ACP outcome constructs and rate the importance of these outcomes. Methods. This study convened a Delphi panel consisting of 52 multidisciplinary, international ACP experts including clinicians, researchers, and policy leaders from four countries. We conducted literature reviews and solicited attendee input from five international ACP conferences to identify initial ACP outcome constructs. In five Delphi rounds, we asked panelists to rate patient-centered outcomes on a seven-point not-at-all to extremely important scale. We calculated means and analyzed panelists' input to finalize an Organizing Framework and outcome rankings. Results. Organizing Framework outcome domains included process (e.g., attitudes), actions (e.g., discussions), quality of care (e.g., satisfaction), and health care (e.g., utilization). The top five outcomes included 1) care consistent with goals, mean 6.71 (+/-SD 0.04); 2) surrogate designation, 6.55 (0.45); 3) surrogate documentation, 6.50 (0.11); 4) discussions with surrogates, 6.40 (0.19); and 5) documents and recorded wishes are accessible when needed 6.27 (0.11). Advance directive documentation was ranked 10th, 6.01 (0.21). Panelists raised caution about whether care consistent with goals can be reliably measured. Conclusion. A large, multidisciplinary Delphi panel developed an Organizing Framework and rated the importance of ACP outcome constructs. Top rated outcomes should be used to evaluate the success of ACP initiatives. More research is needed to create reliable and valid measurement tools for the highest rated outcomes, particularly care consistent with goals. Published by Elsevier Inc. on behalf of American Academy of Hospice and Palliative Medicine.
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