Patient desires: a model for assessment of patient preferences for care of severe or terminal illness.

Full Abstract

OBJECTIVE:
Patient-centered care is better achieved through a comprehensive understanding of patients' preferences for how they want to live their life and how they want to influence their own death. Though much has been written on identifying goals of care, it is often difficult for clinicians to articulate patient goals to guide care planning. We explored the literature on patient's preferences for their care in chronic or life-limiting illness to develop a model for assessment of patient perspectives. We then illustrated our model with composite patients from our clinics and we provide questions to guide patient discussion.

METHODS:
We searched MEDLINE from 1986 to 2004 for primary research articles that relate primarily to a patient's preferences for his or her care. We reviewed over 3500 titles, abstracts, and research papers. Hundreds of articles described patients' quality of life, health status, or satisfaction. We excluded consensus guidelines, non-English papers, reviews, and articles focused on medical professional perspectives. Forty-eight studies focused primarily on patient preferences. Using an iterative process, we identified unique issues and broader themes in patients' desires for their care.

RESULTS:
Studies focused on patients with cancer, those in hospice or those with terminal disease. Three domains emerged:
patient feelings about disease, feelings about suffering, and feelings about the circumstances of death. Attention was given to the differences between patients in terms of the strength and persistence of feelings in each domain.

SIGNIFICANCE OF RESULTS:
Based on existing data, there are three fundamental domains of patient perspective that influence preferences for care. These domains can be assessed by the care team to guide the development of a plan of care and to identify areas of conflict. Our review identifies gaps in the end-of-life literature and areas for future work in patient preferences.

Learn Faster Today Improve your study skills

Author information

Author/s: Knops, Karen M (KM); Srinivasan, Malathi (M); Meyers, Fredrick J (FJ);

Affiliation: Department of Medicine, University of California, Davis Medical Center, Sacramento, California, USA. karen.knops(-atsign-)ahsys.org

Journal and publication information

Publication Type: Journal Article; Review

Journal: Palliative & supportive care (Palliat Support Care), published in England. (Language: eng)

Reference: 2005-Dec; vol 3 (issue 4) : pp 289-99

Dates: Created 2006/10/16; Completed 2007/01/29;

PMID: 17039984, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

External Links for this article (including full text providers, if available):

Click Electronic Full-text Provider Links to see options for finding the electronic full text links to this article. Note there may be a subscription or fee required for access to the full text. See our FAQ for information on finding FREE full text articles.

This article may also be located in paper journal collections available in many libraries. Use the Journal and Publication Information above to find the full article.

MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Attitude to Death
Choice Behavior
Chronic Disease
Humans
Models, Psychological
Neoplasms - nursing; psychology

These are the highest related articles currently in the database:

Paediatric palliative care: coming of age in oncology? 9 Apr 2008
Palliative chemotherapy preferences and factors that influence patient choice in incurable advanced cancer. 29 Jan 2008
Assessing pain in patients. 30 Jan 2008
Assisted dying: a time for change. 30 Jul 2008
Assisted dying: no change in the law is necessary. 30 Jul 2008
A forced choice: the value of requiring advance directives. 30 Dec 2007
End-of-life care: improving quality of life at the end of life. 30 Oct 2007
Communication in end-of-life cardiac care 1: difficult issues. 28 Feb 2008
Framing effect debiasing in medical decision making. 25 Dec 2007
Preferences for location of death of seriously ill hospitalized patients: perspectives from Canadian patients and their family caregivers. 30 Dec 2007

See 100+ related articles.