ArticleJournal of pain and symptom management2019
Goals-of-Care Decisions by Hospitalized Patients With Advanced Cancer: Missed Clinician Opportunities for Facilitating Shared Decision-Making.
Article in Journal of pain and symptom management, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it, 19 citations in OpenAlex.
- Family involvement in advance care planning for people living with advanced cancer: A systematic mixed-methods review.Palliative medicine · 2022Pooled it
- Serious Illness and Health Care Threats to Personal Legacy Goals.The Permanente journal · 2026Article
- Characterizing Physician Recommendations within Code Status Documentation: A Multicentre Cohort Study and Qualitative Discourse Analysis.Journal of general internal medicine · 2026Article
- "Treatable not curable": trade-offs in the use of treatment-oriented language with patients who have incurable cancer.The oncologist · 2025Article
- Understanding how shared decision-making approaches and patient aids influence patients with advanced cancer when deciding on palliative treatments and care: A realist review.Health expectations : an international journal of public participation in health care and health policy · 2023Review
- Code status orders in hospitalized patients with COVID-19.Resuscitation plus · 2023Article
- Barriers and facilitators for shared decision-making in oncology inpatient practice: an explorative study of the healthcare providers' perspective.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2022Article
- Characterizing uncertainty in goals-of-care discussions among black and white patients: a qualitative study.BMC palliative care · 2022Article
- Medical decisions concerning the end of life for cancer patients in three Colombian hospitals - a survey study.BMC palliative care · 2021Article
- Unplanned Admission to the ICU: A Qualitative Study Examining Family Member Experiences.Chest · 2020Article
Corrections and comments
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
Abstract
contextHospitalized patients with advanced cancer often face complex, preference-sensitive decisions. How clinicians and patients engage in shared decision-making during goals-of-care discussions is not well understood.
objectiveThe objective of this study was to explore decision-making by patients and clinicians during inpatient goals-of-care discussions.
methodsThis is a qualitative study of audio-recorded goals-of-care discussions between hospitalized patients with advanced cancer and their clinicians. Grounded theory was used to analyze transcripts.
resultsSixty-two patients participated in goals-of-care discussions with 51 unique clinicians. Nearly half of patients (n = 30) were female and their mean age was 60.1 years (SD = 12.7). A palliative care attending or fellow was present in 58 of the 62 discussions. Decisions centered on three topics: 1) disease-modifying treatments; 2) hospice; and 3) code status. Clinicians' approach to decision-making included the following stages: "information exchange," "deliberation," "making a patient-centered recommendation," and "wrap-up: decisional status." Successful completion of each stage varied by the type of decision. When discussing code status, clinicians missed opportunities to engage patients in information exchange and to wrap up decisional status. By contrast, clinicians discussing disease-modifying treatments and hospice failed to integrate patient preferences. Clinicians also missed opportunities to make patient-centered recommendations when discussing treatment decisions.
conclusionClinicians missed opportunities to facilitate shared decision-making regarding goals of care, and these missed opportunities differed by type of decision being discussed. Opportunities for clinician communication training include engagement in collaborative deliberation with patients and making patient-centered recommendations in situations of high medical uncertainty.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.