A qualitative study of goals of hospital care and health outcome goals among patients admitted for heart failure.

Abstract

We sought to understand how hospitalized older adults describe their goals for hospital care. Eliciting patient healthcare goals is the first domain of the Center for Medicare and Medicaid Services' Age Friendly Hospital measure. Heart failure, a leading cause of hospitalization and readmission in older adults, is an ideal condition for exploring how hospitalized patients articulate goals. We conducted qualitative interviews with 24 patients admitted for heart failure, using the Patient Priorities Care (PPC) framework to identify their goals for hospitalization and health outcome goals. PPC is a communication intervention that identifies patients' values and health outcome goals to guide shared decision-making. Patients' goals for hospitalization were clear and uniform: to feel better and go home. Values and health outcome goals centered on independence, social connection, and maintaining routines, which patients experienced as disconnected from recurrent hospitalizations that provided only short-term symptom relief. Patients articulated goals of hospitalization related to short-term symptom relief, but felt that over the longer term, hospital care was disconnected from their broader health priorities. When eliciting goals for hospitalization, clinicians should connect immediate treatment goals with patients' broader values and realistic health outcome goals through explicit discussion of prognosis and tradeoffs.