Background: Hospitalized patients with a wide range of serious, but not necessarily terminal
illnesses are now receiving palliative care consultations. The purpose of this report is to describe
what palliative care patients say is "most important to achieve" at the time of initial
consultation.
Methods: We conducted a retrospective descriptive content analysis of patient responses to
the question "What is most important for you to achieve?" recorded at the time of initial inpatient
palliative care consultation. Two hundred fifteen patient records had documented
first-person patient responses recorded. These responses were independently reviewed and
categorized in a four-phase iterative process.
Results: Responses were divided into four major categories: (1) Improving quality and
meaning ("I want to be able to sit on my front porch and watch the farm go by.") (52%); (2)
Achieving relief or comfort ("Can you get rid of my pain?") (34%); (3) Altering the trajectory
of illness ("If there is a treatment that can make me well, I want it.") (22%); and (4) Preparing
for dying ("I am not afraid of dying. I just don't want to suffer.") (11%). Five percent of
responses were unable to be reliably categorized ("You ask hard questions."). Some respondents
gave more than one response, so the total is greater than 100%.
Conclusions: Patients receiving palliative care consultation give a wide range of responses
to the question "What is most important for you to achieve?" Such patient-centered inquiry
about priorities deserves more systematic study in the future if patient-specific goals are to
be a marker of high-quality palliative care.
