According to a study published in JAMA Internal Medicine, the patient-specific Jumpstart-Tips intervention increased patient reports and clinician documentation of goals-of-care communication with patients with serious illness. In patients with stable goals, patient-reported goal-concordant care increased as well, indicating improved patient-centered care.
Good clinician communication on the goals of care for patients with serous illness is associated with improved patient outcomes and reduced intensity of end-of-life care. However, many physicians do not talk with patients about their prognosis or the goals of care.
J. Randall Curtis, MD, MPH, of Cambia Palliative Care Center of Excellence at the University of Washington in Seattle, Washington, and colleagues conducted a multicenter cluster-randomized trial (Improving Communication About Serious Illness [ICSI]; ClinicalTrials.gov identifier NCT01933789) in outpatient clinics with 132 clinicians (physicians and nurse practitioners) and 537 patients with serious illness. Conducted between 2012 and 2016, the study sought to determine if a patient-specific preconversation communication-priming intervention (Jumpstart-Tips), which targets both patients with serious illness and clinicians, could increase the goals-of-care conversations compared with usual care. The most common serious chronic illness was advanced cancer.
The Jumpstart-Tips intervention resulted in an increased occurrence and quality of goals-of-care discussion. Among patients in the intervention group, 74% were involved in such a discussion as compared with 31% in the usual care group (P <.001). Clinician electronic health record (EHR) documentation of such a discussion was also higher in the intervention group (62%) compared with 17% for the usual care group (P <.001). Quality ratings of the goals-of-care discussion were higher as well in the intervention group than the usual care group (mean values 4.6 vs 2.1; P =.01).
Patients’ reports of their primary healthcare goal (comfort vs life extension) and the primary focus of their current care showed a nonsignificant treatment effect on goal-concordant care 3 months after the target intervention. However, among patients who maintained a stable goal between the 3-month follow-up and their last prior assessment, the effect on goal-concordant care was significant (73% vs 57%; P =.03). However, the authors found no differences in symptoms of depression or anxiety at 3 or 6 months between the intervention and usual care groups.
The authors conclude that further studies are needed to evaluate whether Jumpstart-Tips is associated with improvements in healthcare delivery.
Curtis JR, Downey L, Back AL, et al. Effect of a patient and clinician communication-priming intervention on patient-reported goals-of-care discussions between patients with serious illness and clinicians. JAMA Intern Med. 2018;178(7):930-940.