Goal Concordance in the Advancing Symptom Alleviation with Palliative Treatment Clinical Trial of a Nurse and Social Worker Palliative Telecare Team Intervention

Abstract

Background:

Providing and measuring goal-concordant care is a priority.

Objective:

Determine the effect of a nurse and social worker palliative telecare team intervention on goal concordance and participants’ understanding of care focus.

Design:

Randomized clinical trial of a palliative telecare intervention called Advancing Symptom Alleviation with Palliative Treatment (ADAPT). As part of ADAPT, a study nurse and/or social worker had a serious illness conversation via phone.

Setting/Subjects:

Participants had cardiopulmonary disease and poor quality of life in two VA health systems.

Measurements:

Goal concordance was measured with two questions modified from the SUPPORT study, using a Likert scale from 0 (I prefer medical care that focuses on extending life) to 10 (I prefer medical care that focuses on relieving pain and discomfort). Participants could choose, “I am unsure” when asked about the focus of their current medical care. Goal concordance was defined when participants reported the same preference and focus of care. Using linear mixed modeling, changes in proportions of concordant and unsure participants were examined from baseline to six months.

Results:

The 306 participants enrolled in the ADAPT trial were predominantly white (80.1%) and male (90.2%), with a mean age of 68.9 (standard deviation: 7.7) years. There was no difference in the change in proportions of concordant participants in the intervention group compared to usual care (adjusted difference in change in proportions: 4.2%; p = 0.67) or the change in proportions of unsure participants (adjusted difference in change of proportions: 6.2%; p = 0.42).

Conclusion:

The intervention did not influence goal concordance or the proportion of participants unsure of care focus.