Goals of care discussions in hospitalised patients: systematic review of randomised trials.

IF 2.5 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

BMJ Supportive & Palliative Care Pub Date : 2026-06-29 DOI:10.1136/spcare-2025-005827

Carina DiDiodato, Chris Martin, Doug Austgarden, Jesse McLean, Giulio DiDiodato

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引用次数: 0

Abstract

Importance: Structured communication tools and decision aids are recommended to facilitate goals of care discussions (GOCDs) in hospitalised patients, but their impact remains unclear.

Objective: To determine the effectiveness of communication tools and decision aids on GOCDs between healthcare providers, patients and substitute decision makers.

Data sources: PubMed, Web of Science, CINAHL and ClinicalTrials.gov were searched from January 2015 to July 2025, with backward citation tracking to identify additional trials.

Study selection: Randomised trials of communication tools or decision aids for hospitalised adults or substitute decision makers were eligible, regardless of primary outcomes.

Data extraction and synthesis: Trial characteristics, primary outcomes and methodological quality were extracted and assessed using the Core Grading of Recommendations, Assessment, Development and Evaluation framework. Random-effects meta-analyses were conducted when appropriate.

Results: 22 trials were included. Communication tools increased GOCD documentation (OR 1.46, 95% CI 1.04 to 2.05). Effects on resuscitation preferences were inconsistent (OR 1.84, 95% CI 0.95 to 3.60). Mixed effects were observed for concordant care, psychosocial outcomes and healthcare utilisation. Evidence certainty was moderate for most outcomes; several small pilot trials were rated low due to bias, imprecision or heterogeneity. Interventions were most effective when combining structured patient-facing or clinician-facing prompts such as videos, guides or electronic health record alerts.

Conclusions and relevance: Communication tools and decision aids improve GOCD documentation in hospitalised patients but show uncertain effects on other patient-centred outcomes or healthcare utilisation. Interprofessional training and system-level support may enhance impact, and future large trials should evaluate the effectiveness of facilitated GOCDs on important patient and health system outcomes.

查看原文本刊更多论文

住院患者护理讨论的目标：随机试验的系统评价。

重要性：建议使用结构化沟通工具和决策辅助工具来促进住院患者的护理讨论目标（gocd），但其影响尚不清楚。目的：确定医疗服务提供者、患者和替代决策者之间沟通工具和决策辅助工具对gocd的有效性。数据来源：PubMed， Web of Science， CINAHL和ClinicalTrials.gov检索时间为2015年1月至2025年7月，通过反向引文跟踪来识别额外的试验。研究选择：适用于住院成人或替代决策者的通讯工具或决策辅助工具的随机试验，无论主要结果如何。数据提取和综合：使用建议、评估、发展和评价核心分级框架提取和评估试验特征、主要结果和方法学质量。适当时进行随机效应荟萃分析。结果：共纳入22项试验。通信工具增加了GOCD文档（OR 1.46, 95% CI 1.04 - 2.05）。对复苏偏好的影响不一致（OR 1.84, 95% CI 0.95至3.60）。在和谐护理、社会心理结局和医疗保健利用方面观察到混合效应。大多数结果的证据确定性为中等；几项小型试点试验由于偏倚、不精确或异质性而被评为低水平。当结合结构化的面向患者或面向临床医生的提示（如视频、指南或电子健康记录警报）时，干预措施最有效。结论和相关性：沟通工具和决策辅助可以改善住院患者的GOCD记录，但对其他以患者为中心的结果或医疗保健利用的影响尚不确定。跨专业培训和系统层面的支持可能会增强影响，未来的大型试验应评估促进gocd对重要患者和卫生系统结果的有效性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

BMJ Supportive & Palliative Care Medicine-Medicine (miscellaneous)

CiteScore

4.60

自引率

7.40%

发文量

170

期刊介绍： Published quarterly in print and continuously online, BMJ Supportive & Palliative Care aims to connect many disciplines and specialties throughout the world by providing high quality, clinically relevant research, reviews, comment, information and news of international importance. We hold an inclusive view of supportive and palliative care research and we are able to call on expertise to critique the whole range of methodologies within the subject, including those working in transitional research, clinical trials, epidemiology, behavioural sciences, ethics and health service research. Articles with relevance to clinical practice and clinical service development will be considered for publication. In an international context, many different categories of clinician and healthcare workers do clinical work associated with palliative medicine, specialist or generalist palliative care, supportive care, psychosocial-oncology and end of life care. We wish to engage many specialties, not only those traditionally associated with supportive and palliative care. We hope to extend the readership to doctors, nurses, other healthcare workers and researchers in medical and surgical specialties, including but not limited to cardiology, gastroenterology, geriatrics, neurology, oncology, paediatrics, primary care, psychiatry, psychology, renal medicine, respiratory medicine.