Patient-provider care goal concordance: implications for palliative care decisions

Objective: Goal-concordant care is an important feature of high quality medical treatment. Patients’ care goals may focus on curative and/or palliative outcomes. Patients rarely communicate their care goals, and providers’ predictions of patient goals are often inaccurate, corresponding most closely to their own treatment goals. This projection of own goals onto patients introduces the potential for bias, leading to goal-discordant care.

Design and Main Outcomes: We examined goal discordance using data from a U.S. sample of healthcare providers (N?=?492) recruited online in 2017 using GfK Knowledge Panel. Providers reported their perceptions of their patients’ care goals (curative relative to palliative), their own care goals if they were to become ill, and their willingness to deliver palliative care.

Results: For 28% of providers, their own care goals differed from their patients’. Providers were more likely to prioritise palliative care (relative to curative) in their own goals than in their predictions about patients’ goals. Providers were more willing to deliver palliative care when their own goals prioritised more palliative relative to curative care, but their perceptions of patient goals were unassociated with willingness to provide it.

Conclusions: Efforts to improve goal communication and reduce projection biases among providers may facilitate goal-concordant care.     

Pain,emotion, and the situational specificity of catastrophising

Two studies were designed to explore the cross-situational nature of catastrophising and the emotions associated with pain and catastrophising. The crosssituational consistency of catastrophising in response to a finger-pressure procedure and during an episode of headache pain was examined in the first study. The second study examined differences between catastrophisers and noncatastrophisers with respect to state and trait measures of positive and negative emotions. Results of study one indicated that almost half of the subjects remained consistent in their classification as catastrophiser or noncatastrophiser in both pain situations. The majority of subjects that switched classification changed from being classified as catastrophisers during the headache experience to noncatastrophisers during the finger-pressure procedure. Results of the second study indicated that catastrophisers experienced significantly greater fear, sadness, anger, hostility, guilt, disgust, and shame during the finger-pressure procedure as compared to noncatastrophisers. Unexpectedly, catastrophisers were not a homogeneous group in regard to the pattern of negative emotions reported. Catastrophisers with headaches experienced greater sadness in response to finger-pressure pain than catastrophisers without headaches. Theoretical and clinical implications of these findings are discussed.     

Varieties of object constancy

Three experiments are described in which two pictures of isolated man-made objects were presented in succession. The subjects' task was to decide, as rapidly as possible, whether the two pictured objects had the same name. With a stimulus-onset asynchrony (SOA) of above 200 msec two types of facilitation were observed: (1) the response latency was reduced if the pictures showed the same object, even though seen from different viewpoints (object benefit); (2) decision time was reduced further if the pictures showed the same object from the same angle of view (viewpoint benefit). These facilitation effects were not affected by projecting the pictures to different retinal locations. Significant benefits of both types were also obtained when the projected images differed in size. However, in these circumstances there was a small but significant performance decrement in matching two similar views of a single object, but not if the views were different. Conversely, the object benefit, but not the viewpoint benefit, was reduced when the SOA was only 100 msec. The data suggest the existence of (at least) two different visual codes, one non-retinotopic but viewer-centred, the other object-centred.