Patient-reported discordance between care goals and treatment intent in advanced cancer.

Abstract

Goal-concordant care is achieved when treatment is aligned with goals. This study describes patient-reported concordance between care goals and treatment intent in advanced cancer compared to other serious illnesses. A post hoc cross-sectional analysis of baseline survey responses was conducted in adult patients enrolled in a multisite trial of advance care planning. Patients reported whether they prefer and whether they are receiving treatment that prioritizes longevity (life-extending care) versus comfort (comfort-focused care). Concordance between care preferences and perceived treatment intent in patients with advanced cancer versus other advanced illnesses was compared. Mortality rates for patients with cancer stratified by perceived care concordance are reported. Among 1099 patients, those with advanced cancer (n = 231) reported similar preference for comfort-focused care (49% vs 48%, p = .47) and had similar 24-month mortality (16% v 13%, p = .25) as patients with other serious illnesses (n = 868). Among patients preferring comfort-focused care, patients with cancer (n = 113) were more likely than patients with other illnesses (n = 413) to report receiving (discordant) life-extending care (37% vs. 19%, p < .001). Among patients with cancer preferring comfort-focused care, there was no statistically significant difference in 24-month mortality between those who reported receiving (discordant) life-extending versus (concordant) comfort-focused care (24% v 15%, p = .31). Compared to patients with other serious illnesses, a relatively large portion of patients with advanced cancer reported that their treatment discordantly focused on longevity over comfort despite their goal to prioritize comfort over longevity.