Patients’ wishes regarding goals of care should be assessed frequently, similar to assessments for distress, to ensure patients’ wishes are understood and followed at the end of life (EOL). Use of a single-item visual analog scale (VAS) was found to identify patients’ goals of care throughout their cancer trajectory and help oncologists to better understand their patients’ goals of care at the end of life, according to a study published in Supportive Care in Cancer.
Understanding the wishes of patients with advanced cancer regarding EOL care is considered a measure of quality care; however, patients often receive more aggressive treatment than is supported by their goals of care. This can occur when oncologists’ perceptions of their patient’s wishes do not match the patient’s actual wishes. A study was conducted to determine the influence of patient–oncologist agreement regarding goals of care for patients with advanced cancer.
For the study, researchers identified 524 eligible patients, 378 of whom consented to participate. Oncologists enrolled in the study were the primary oncologist for the patients who had agreed to participate. Eleven oncologists were eligible, and all agreed to participate. The outcome measured was whether aggressiveness of care at EOL matched patients’ wishes for goals of care.
The decision to use a single-item VAS was based on research that demonstrated that the modality offered a lower risk of bias from confounding factors, avoidance of the ceiling effect, and the survey could be completed more quickly than one using Likert-scaled items.
The question for patients was, “Regarding your care, what is most important to you right now?” For oncologists, the question was, “Regarding the care of this patient, what do you think is most important to the patient right now?” Responses were on a scale of 0 to 100, with 0 indicating “quality of life is all that matters” (ie, the goal of care was for comfort) and 100 indicating “length of life is all that matters” (ie, the goal of care was for survival).
Strong agreement was defined as goal of care scores from the patient and the oncologist being closely aligned. For example, with survival strong goal of care agreement indicated when both patient and oncologist responses were between 70 and 100. For comfort, strong goal of care agreement was indicated when both responses were between 0 and 30.