Article

What is most important for you to achieve?: An analysis of patient responses when receiving palliative care consultation

Center for Palliative Care and Clinical Ethics, University of Rochester Medical Center, NY 14642, USA.
Journal of Palliative Medicine (Impact Factor: 2.06). 05/2006; 9(2):382-8. DOI: 10.1089/jpm.2006.9.382
Source: PubMed

ABSTRACT 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.
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.
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%.
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.

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    • "One way to help this process flourish, I would suggest, is to adopt the latest developments in narrative inquiry from the perspective of spiritual and religious care. Whereas previous studies have illuminated how palliative care patients responded to singular openended questions such as, " What is most important for you to achieve? " (Quill et al., 2006), and " What bothers you the most? " (Shah et al., 2008), I begin with the spiritual assessment question: " What spiritual strengths does the patient draw upon to address his or her spiritual needs/distresses? "
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