Truth telling and treatment strategies in end-of-life care in physician-led accountable care organizations: Discrepancies between patients' preferences and physicians' perceptions
Journal
Medicine (United States)
Journal Volume
94
Journal Issue
16
Pages
e657
Date Issued
2015
Author(s)
Abstract
Providing patient-centered care from preventive medicine to end-of-life care in order to improve care quality and reduce medical cost is important for accountable care. Physicians in the accountable care organizations (ACOs) are suitable for participating in supportive end-of-life care especially when facing issues in truth telling and treatment strategy. This study aimed to investigate patients' attitudes toward truth telling and treatment preferences in end-of-life care and compare patients' attitudes with their ACOs physicians' perceptions. This nationwide study applied snowball sampling to survey physicians in physician-led ACOs and their contracted patients by questionnaire from August 2010 to July 2011 in Taiwan. The main outcome measures were beliefs about palliative care, attitudes toward truth telling, and treatment preferences. The data of 314 patients (effective response rate=88.7%) and 177 physicians (88.5%) were analyzed. Regarding truth telling about disease prognosis, 94.3% of patients preferred to be fully informed, whereas only 80% of their physicians had that perception (P<0.001). Significant differences were also found in attitudes toward truth telling even when encountering terminal disease status (98.1% vs 85.3%). Regarding treatment preferences in terminal illness, nearly 90% of patients preferred supportive care, but only 15.8% of physicians reported that their patients had this preference (P<0.001). Significant discrepancies exist between patients' preferences and physicians' perceptions toward truth telling and treatment strategies in end-of-life care. It is important to enhance physician-patient communication about end-of-life care preferences in order to achieve the goal of ACOs. Continuing education on communication about end-of-life care during physicians' professional development would be helpful in the reform strategies of establishing accountable care around the world. ? 2015 Wolters Kluwer Health, Inc. All rights reserved.
SDGs
Other Subjects
accountable care organization; adult; Article; attitude to health; continuing education; doctor patient relation; female; health belief; health care cost; health status; human; interpersonal communication; life sustaining treatment; major clinical study; male; medical information; outcome assessment; palliative therapy; patient attitude; patient preference; physician attitude; priority journal; professional development; prognosis; self report; snowball sample; terminal care; terminal disease; terminally ill patient; total quality management; truth telling; accountable care organization; middle aged; patient preference; perception; physician; procedures; psychology; socioeconomics; Taiwan; Accountable Care Organizations; Adult; Female; Humans; Male; Middle Aged; Palliative Care; Patient Preference; Perception; Physician-Patient Relations; Physicians; Socioeconomic Factors; Taiwan; Truth Disclosure
Publisher
Lippincott Williams and Wilkins
Type
journal article