A New Standard for Advance Care Planning (ACP) Conversations in the Hospital: Results from a Delphi Panel.

Abstract:

BACKGROUND:Fewer than half of the US population has an advance healthcare directive. Hospitalizations offer a key opportunity for clinicians to engage patients in advance care planning (ACP) conversations. Guidelines suggest screening for the presence of "serious illness" but do not further specify how to prioritize the 12.4 million patients hospitalized each year. OBJECTIVE:To establish a normative standard for prioritizing hospitalized patients for ACP conversations. DESIGN AND SETTING:A modified Delphi study, with three iterative rounds of online surveys. PARTICIPANTS:Multi-disciplinary group of US-based clinicians with research and practical expertise in ACP. MAIN MEASURES:Indirect and direct elicitation of short-term and 1-year risk of mortality that prompt experts to prioritize ACP conversations for hospitalized adults. MAIN RESULTS:Fifty-seven of 108 (52%) candidate panelists completed round 1, and 47 completed rounds 2 and 3. Panelists were primarily physicians (84%), with significant experience (mean years 23 [SD 9.8]), who either taught (55%) and/or performed research about ACP (55%). In round 1, > 70% of panelists agreed that all hospitalized adults ≥ 65 years should have an ACP conversation before discharge, but disagreed about the timing and content of the conversation. By round 3, > 70% of participants agreed that patients with either high (> 10%) short-term or high (≥ 34%) 1-year risk of mortality should have a goals of care conversation (i.e., focused on preferences for near-term treatment), while patients with low (≤ 10%) short-term and low (< 19%) 1-year risk of mortality warranted an ACP conversation (i.e., focused on preferences for future care) before discharge. LIMITATIONS:Use of case vignettes to elicit clinician judgment; response rate. CONCLUSIONS:Panelists agreed that clinicians should have an ACP conversation with all hospitalized adults over 65 years in an ACP conversation, adjusting the content and timing of the conversation conditional on the patient's risk of short-term and 1-year mortality.

journal_name

J Gen Intern Med

authors

Mohan D,Sacks OA,O'Malley J,Rudolph M,Bynum J,Murphy M,Barnato AE

doi

10.1007/s11606-020-06150-0

subject

Has Abstract

pub_date

2020-08-20 00:00:00

eissn

0884-8734

issn

1525-1497

pii

10.1007/s11606-020-06150-0

pub_type

杂志文章
  • Food insecurity is associated with diabetes mellitus: results from the National Health Examination and Nutrition Examination Survey (NHANES) 1999-2002.

    abstract:BACKGROUND:Food insecurity refers to limited or uncertain access to food resulting from inadequate financial resources. There is a clear association between food insecurity and obesity among women, but little is known about the relationship between food insecurity and type 2 diabetes. OBJECTIVE:To evaluate whether the...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-007-0192-6

    authors: Seligman HK,Bindman AB,Vittinghoff E,Kanaya AM,Kushel MB

    更新日期:2007-07-01 00:00:00

  • Randomized Controlled Trial of Brief Mindfulness Training and Hypnotic Suggestion for Acute Pain Relief in the Hospital Setting.

    abstract:BACKGROUND:Medical management of acute pain among hospital inpatients may be enhanced by mind-body interventions. OBJECTIVE:We hypothesized that a single, scripted session of mindfulness training focused on acceptance of pain or hypnotic suggestion focused on changing pain sensations through imagery would significantl...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,随机对照试验

    doi:10.1007/s11606-017-4116-9

    authors: Garland EL,Baker AK,Larsen P,Riquino MR,Priddy SE,Thomas E,Hanley AW,Galbraith P,Wanner N,Nakamura Y

    更新日期:2017-10-01 00:00:00

  • Hospital discharge instructions: comprehension and compliance among older adults.

    abstract:BACKGROUND:Little is known regarding the prevalence or risk factors for non-comprehension and non-compliance with discharge instructions among older adults. OBJECTIVE:To quantify the prevalence of non-comprehension and non-compliance with discharge instructions and to identify associated patient characteristics. RESE...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-014-2956-0

    authors: Albrecht JS,Gruber-Baldini AL,Hirshon JM,Brown CH,Goldberg R,Rosenberg JH,Comer AC,Furuno JP

    更新日期:2014-11-01 00:00:00

  • Impact of patient race on patient experiences of access and communication in HIV care.

    abstract:BACKGROUND:Patient-centered care--including the domains of access and communication--is an important determinant of positive clinical outcomes. OBJECTIVE:To explore associations between race and HIV-infected patients' experiences of access and communication. DESIGN:This was a cross-sectional survey. PARTICIPANTS:Nin...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,多中心研究

    doi:10.1007/s11606-008-0788-5

    authors: Korthuis PT,Saha S,Fleishman JA,McGrath MM,Josephs JS,Moore RD,Gebo KA,Hellinger J,Beach MC,HIV Research Network.

    更新日期:2008-12-01 00:00:00

  • Quality of care and racial disparities in medicare among potential ACOs.

    abstract:BACKGROUND:The Medicare Accountable Care Organization (ACO) programs encourage integration of providers into large groups and reward provider groups for improving quality, but not explicitly for reducing health care disparities. Larger group size and better overall quality may or may not be associated with smaller disp...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,随机对照试验

    doi:10.1007/s11606-014-2900-3

    authors: Anderson RE,Ayanian JZ,Zaslavsky AM,McWilliams JM

    更新日期:2014-09-01 00:00:00

  • Barriers to excellent end-of-life care for patients with dementia.

    abstract::While great strides have been made recently in improving end-of-life care in the United States, people with dementia often die with inadequate pain control, with feeding tubes in place, and without the benefits of hospice care. In this paper, we discuss the most important and persistent challenges to providing excelle...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,评审

    doi:10.1111/j.1525-1497.2004.30329.x

    authors: Sachs GA,Shega JW,Cox-Hayley D

    更新日期:2004-10-01 00:00:00

  • Exploring the educational value of clinical vignettes from the Society of General Internal Medicine national meeting in the internal medicine clerkship: a pilot study.

    abstract:INTRODUCTION:Whether the clinical vignettes presented at the Society of General Internal Medicine (SGIM) annual meeting could be of educational value to third year students in the Internal Medicine clerkship has not been studied. OBJECTIVE:To explore the relevance and learning value of clinical vignettes from the SGIM...

    journal_title:Journal of general internal medicine

    pub_type:

    doi:10.1111/j.1525-1497.2006.00596.x

    authors: Wofford JL,Singh S

    更新日期:2006-11-01 00:00:00

  • VA location and structural factors associated with on-site availability of reproductive health services.

    abstract:INTRODUCTION:With the increasing number of women Veterans enrolling in the Veterans Health Administration (VA), there is growing demand for reproductive health services. Little is known regarding the on-site availability of reproductive health services at VA and how this varies by site location and type. OBJECTIVE:To ...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,多中心研究

    doi:10.1007/s11606-012-2289-9

    authors: Katon J,Reiber G,Rose D,Bean-Mayberry B,Zephyrin L,Washington DL,Yano EM

    更新日期:2013-07-01 00:00:00

  • Are opioid dependence and methadone maintenance treatment (MMT) documented in the medical record? A patient safety issue.

    abstract:BACKGROUND:Opioid-dependent patients often have co-occurring chronic illnesses requiring medications that interact with methadone. Methadone maintenance treatment (MMT) is typically provided separately from medical care. Hence, coordination of medical care and substance use treatment is important to preserve patient sa...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-009-1043-4

    authors: Walley AY,Farrar D,Cheng DM,Alford DP,Samet JH

    更新日期:2009-09-01 00:00:00

  • A Summary Report from the Research Partnership on Women in Science Careers.

    abstract:BACKGROUND:In response to the landmark report "Beyond Bias and Barriers: Fulfilling the Potential of Women in Academic Science and Engineering," the NIH Office of Research on Women's Health issued a request for applications that funded 14 R01 grants to investigate causal factors to career success for women in STEM. Fol...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,评审

    doi:10.1007/s11606-018-4547-y

    authors: Carr PL,Helitzer D,Freund K,Westring A,McGee R,Campbell PB,Wood CV,Villablanca A

    更新日期:2019-03-01 00:00:00

  • Teaching residents to work with torture survivors: experiences from the Bronx Human Rights Clinic.

    abstract:INTRODUCTION:Despite the 1984 United Nations's Convention Against Torture calling to train doctors to work with torture survivors, many physicians are unaware of their obligation and few are taught the requisite clinical skills. AIM:To describe the development, implementation, and evaluation of a curriculum to teach r...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-008-0592-2

    authors: Metalios EE,Asgary RG,Cooperman N,Smith CL,Du E,Modali L,Sacajiu G

    更新日期:2008-07-01 00:00:00

  • Impact of health literacy on depressive symptoms and mental health-related: quality of life among adults with addiction.

    abstract:BACKGROUND:Health literacy has been linked to health status in a variety of chronic diseases. However, evidence for a relationship between health literacy and mental health outcomes is sparse. OBJECTIVE:We hypothesized that low literacy would be associated with higher addiction severity, higher levels of depressive sy...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,随机对照试验

    doi:10.1111/j.1525-1497.2006.00533.x

    authors: Lincoln A,Paasche-Orlow MK,Cheng DM,Lloyd-Travaglini C,Caruso C,Saitz R,Samet JH

    更新日期:2006-08-01 00:00:00

  • What Quality and Safety of Care for Patients Admitted to Clinically Inappropriate Wards: a Systematic Review.

    abstract:BACKGROUND:In countries with public health system, hospital bed reductions and increasing social and medical frailty have led to the phenomenon of "outliers" or "outlying hospital in-patients." They are often medical patients who, because of unavailability of beds in their clinically appropriate ward, are admitted wher...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-019-05008-4

    authors: La Regina M,Guarneri F,Romano E,Orlandini F,Nardi R,Mazzone A,Fontanella A,Campanini M,Manfellotto D,Bellandi T,Gussoni G,Tartaglia R,Squizzato A

    更新日期:2019-07-01 00:00:00

  • Measuring primary care organizational capacity for diabetes care coordination: the Diabetes Care Coordination Readiness Assessment.

    abstract:BACKGROUND:Not all primary care clinics are prepared to implement care coordination services for chronic conditions, such as diabetes. Understanding true capacity to coordinate care is an important first-step toward establishing effective and efficient care coordination. Yet, we could identify no diabetes-specific inst...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,多中心研究

    doi:10.1007/s11606-013-2566-2

    authors: Weeks DL,Polello JM,Hansen DT,Keeney BJ,Conrad DA

    更新日期:2014-01-01 00:00:00

  • Providers' perceptions of relationships and professional roles when caring for patients who leave the hospital against medical advice.

    abstract:BACKGROUND:Patients who leave hospitals against medical advice (AMA) may be at risk for adverse health outcomes. Their decision to leave may not be clearly understood by providers. This study explored providers' experiences with and attitudes toward patients who leave the hospital AMA. OBJECTIVE:To explore providers' ...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-008-0728-4

    authors: Windish DM,Ratanawongsa N

    更新日期:2008-10-01 00:00:00

  • The relative importance of physician communication, participatory decision making, and patient understanding in diabetes self-management.

    abstract:OBJECTIVE:Patients' self-management practices have substantial consequences on morbidity and mortality in diabetes. While the quality of patient-physician relations has been associated with improved health outcomes and functional status, little is known about the impact of different patient-physician interaction styles...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1046/j.1525-1497.2002.10905.x

    authors: Heisler M,Bouknight RR,Hayward RA,Smith DM,Kerr EA

    更新日期:2002-04-01 00:00:00

  • Peer Support for Self-Management of Chronic Pain: the Evaluation of a Peer Coach-Led Intervention to Improve Pain Symptoms (ECLIPSE) Trial.

    abstract:BACKGROUND:Pain self-management is an effective, evidence-based treatment for chronic pain. Peer support, in which patients serve as coaches for other patients, has been effective in other chronic conditions and is a potentially promising approach to implementing pain self-management programs using fewer clinical resou...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-020-06007-6

    authors: Matthias MS,Bair MJ,Ofner S,Heisler M,Kukla M,McGuire AB,Adams J,Kempf C,Pierce E,Menen T,McCalley S,Johnson NL,Daggy J

    更新日期:2020-12-01 00:00:00

  • The impact of needle exchange-based health services on emergency department use.

    abstract:OBJECTIVE:To examine the impact of the New Haven Community Health Care Van (CHCV), a mobile needle exchange-based health care delivery system, in reducing emergency department (ED) use among out-of-treatment injection drug users (IDUs) between January 1, 1996 and December 31, 1998. DESIGN:A pre-post comparison of ED u...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:

    authors: Pollack HA,Khoshnood K,Blankenship KM,Altice FL

    更新日期:2002-05-01 00:00:00

  • Predictors Associated with Survival Among Elderly In-Patients Who Receive Cardiopulmonary Resuscitation in Japan: An Observational Cohort Study.

    abstract:BACKGROUND:Little is known about the outcomes of in-hospital cardiopulmonary resuscitation (CPR) in Asian populations including elderly patients in Japan. OBJECTIVE:To determine the survival outcome of in-hospital CPR among elderly patients in Japan, and to identify predictors associated with survival. DESIGN:Retrosp...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-018-4747-5

    authors: Hayashi T,Matsushima M,Bito S,Kanazawa N,Inoue N,Luthe SK,Wee CC

    更新日期:2019-02-01 00:00:00

  • The relationship of patient characteristics to physician delivery of advice to stop smoking.

    abstract::To investigate the frequency of physician delivery of advice to stop smoking and patient characteristics affecting whether physicians deliver such advice, the authors surveyed 97 current cigarette smokers seen in two specialty and one general medicine clinic at a university medical center. Approximately two thirds of ...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/BF02596170

    authors: Ockene JK,Hosmer DW,Williams JW,Goldberg RJ,Ockene IS,Biliouris T,Dalen JE

    更新日期:1987-09-01 00:00:00

  • Survey of Adult Influenza Vaccination Practices and Perspectives Among US Primary Care Providers (2016-2017 Influenza Season).

    abstract:BACKGROUND:Seasonal influenza vaccination is recommended for all adults; however, little is known about how primary care physicians can communicate effectively with patients about influenza vaccination. OBJECTIVE:To assess among general internal medicine (GIM) and family physicians (FP) regarding adult influenza vacci...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-019-05164-7

    authors: Cataldi JR,O'Leary ST,Lindley MC,Hurley LP,Allison MA,Brtnikova M,Beaty BL,Crane LA,Kempe A

    更新日期:2019-10-01 00:00:00

  • A new instrument for residency program evaluation.

    abstract::The purpose of the study was to develop a comprehensive program evaluation instrument. Following pilot work with residents, a 69-item instrument consisting of statements with 5-point strongly agree to strongly disagree response options was distributed to 107 residents; 104 responded. Psychometric analyses revealed no ...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1046/j.1525-1497.1997.07139.x

    authors: Bellini L,Shea JA,Asch DA

    更新日期:1997-11-01 00:00:00

  • Terminal (mis)diagnosis and the physician-patient relationship in LM Montgomery's The Blue Castle.

    abstract::LM Montgomery's The Blue Castle was first published in 1926, yet contains many insights into medical practice that remain relevant today. The protagonist, Valancy, mistakenly receives a terminal diagnosis in a letter from her physician, who has sent her a note intended for another patient. Her interactions with the ph...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-010-1394-x

    authors: Weaver R

    更新日期:2010-10-01 00:00:00

  • Relationship Between Burnout, Professional Behaviors, and Cost-Conscious Attitudes Among US Physicians.

    abstract:BACKGROUND:Despite the importance of professionalism, little is known about how burnout relates to professionalism among practicing physicians. OBJECTIVE:To evaluate the relationship between burnout and professional behaviors and cost-conscious attitudes. DESIGN AND PARTICIPANTS:Cross-sectional study in a national sa...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-019-05376-x

    authors: Dyrbye LN,West CP,Hunderfund AL,Sinsky CA,Trockel M,Tutty M,Carlasare L,Satele D,Shanafelt T

    更新日期:2020-05-01 00:00:00

  • Implementation of local guidelines for cost-effective management of hypertension. A trial of the firm system.

    abstract:OBJECTIVE:To evaluate the effects of an intensive intervention to implement guidelines for cost-effective management of hypertension on medication use and cost, blood pressure control, and other resource use. DESIGN:Retrospective cohort trial based on the Cleveland Veterans' Affairs Medical Center Firm System. SETTIN...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/BF02600265

    authors: Aucott JN,Pelecanos E,Dombrowski R,Fuehrer SM,Laich J,Aron DC

    更新日期:1996-03-01 00:00:00

  • Hospitalized patients' satisfaction with caregivers' conduct and physical surroundings.

    abstract::The study examined the relative contribution of caregivers' conduct and physical conditions of the hospital setting to patients' global satisfaction with health care, while controlling for self-assessed health status. The study was performed in the Soroka Medical Center, which is the only inpatient facility for a popu...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/BF02598274

    authors: Pilpel D

    更新日期:1996-05-01 00:00:00

  • Renal Cell Carcinoma Presenting with Paraneoplastic Hallucinations and Cognitive Decline from Limbic Encephalitis.

    abstract::We present a 66-year-old woman with 2 months of visual hallucinations, unintentional weight loss, and short-term memory decline, whose clinical presentation and EEG supported a diagnosis of limbic encephalitis. Subsequent evaluation for a paraneoplastic etiology revealed a renal mass, which was resected and identified...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-014-3172-7

    authors: Harrison JW,Cherukuri R,Buchan D

    更新日期:2015-07-01 00:00:00

  • Cost-effectiveness of a primary care depression intervention.

    abstract:OBJECTIVE:To determine the incremental cost-effectiveness of a quality improvement depression intervention (enhanced care) in primary care settings relative to usual care. DESIGN:Following stratification, we randomized 12 primary care practices to enhanced or usual care conditions and followed patients for 12 months. ...

    journal_title:Journal of general internal medicine

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验

    doi:10.1046/j.1525-1497.2003.20611.x

    authors: Pyne JM,Rost KM,Zhang M,Williams DK,Smith J,Fortney J

    更新日期:2003-06-01 00:00:00

  • Why Aren't More Primary Care Residents Going into Primary Care? A Qualitative Study.

    abstract:BACKGROUND:Workforce projections indicate a potential shortage of up to 31,000 adult primary care providers by the year 2025. Approximately 80 % of internal medicine residents and nearly two-thirds of primary care internal medicine residents do not plan to have a career in primary care or general internal medicine. OB...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-016-3825-9

    authors: Long T,Chaiyachati K,Bosu O,Sircar S,Richards B,Garg M,McGarry K,Solomon S,Berman R,Curry L,Moriarty J,Huot S

    更新日期:2016-12-01 00:00:00

  • Racial/ethnic differences in cardiovascular risk factors among women veterans.

    abstract:BACKGROUND:Heart disease is the leading cause of death for women in the United States, accounting for 24.5 % of all deaths among women. Earlier research has demonstrated racial/ethnic differences in prevalence of cardiovascular (CVD) risk factors. OBJECTIVE:To empirically examine the prevalence of CVD risk factors amo...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,随机对照试验

    doi:10.1007/s11606-012-2309-9

    authors: Rose DE,Farmer MM,Yano EM,Washington DL

    更新日期:2013-07-01 00:00:00