Journal of the American Medical Directors Association
Original StudiesCan Goal-Based Advance Planning Guide Medical Care in the Nursing Home?
Section snippets
Methods
The pathways approach was described to the staff of a 725-bed teaching nursing home and its affiliated continuing care retirement community. The clinicians were given a one-page document summarizing, for each pathway, the underlying goals and the types of treatment consistent with that approach (Table 1). A scenario-based pencil and paper test was then administered in a proctored setting to measure the usefulness of the pathways system in guiding medical decision making in the nursing home.
Results
Of the 21 tests distributed, 17 tests (81%) were completed. Two tests had to be discarded because the subjects did not fill out the answer sheet correctly: the respondents were asked which of four possible treatments they would recommend given a particular pathway but two respondents instead indicated which pathway corresponded to one of the treatment options listed. Overall, 78% of the answers were correct based on the reference answers, with individual scores ranging from 60% to 100%. When
Discussion
Previous studies have indicated that neither very general advance directives7 nor designation of a single overriding goal8 can reliably be used to infer preferences for specific treatments. We hypothesized that knowledge of a patient's chosen “pathway of care” based on the prioritization of three distinct goals of care would enable clinicians to recommend treatment options in the setting of acute illness. Our results suggest that although the pathway system does not lead to the determination of
Acknowledgments
The authors wish to thank Dan Kiely, MS, of the Research and Training Institute of the Hebrew Rehabilitation Center for Aged, for assistance with the statistical analysis.
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Supported in part by the Hartford American Federation for Aging Research (AFAR) Geriatrics Scholars Program