Don’t offer tests or treatments without establishing your patient’s prognosis, preferences, and goals of care. Tests or treatments that are potentially harmful, won’t improve a patient’s morbidity or mortality or are not consistent with a patient’s goals/wishes can be avoided by having a comprehensive discussion and documenting this information.

Early conversations about disease understanding, wishes, and goals with patients who have serious or progressive chronic illnesses can avoid potentially harmful tests or treatments. Ensuring patients discuss and document wishes and goals, as well as identify a substitute decision-maker can support evidence-informed and patient-centered care.

Sources:

Bernacki RE, et al. for the American College of Physicians High Value Care Task Force. Communication About Serious Illness Care Goals: A Review and Synthesis of Best Practices. JAMA Intern Med. 2014;174(12):1994–2003. PMID: 25330167.

 

Detering KM, et al. The impact of advance care planning on end of life care in elderly patients: randomised controlled trial. BMJ. 2010; 340:1345. PMID: 20332506.

 

Weathers E, et al. Advance care planning: A systematic review of randomised controlled trials conducted with older adults. Maturitas. 2016;91:101–109. PMID: 27451328.