Goals for the care of frail older adults: Do caregivers and clinicians agree?

PURPOSE: Establishing shared treatment goals for patients may improve the q uality of care by facilitating achievement of appropriate and desired outco mes. The purpose of this study was to describe types of family caregiver an d physician treatment goals for frail elderly patients who had a high preva lence of cognitive impairment, and to ascertain the level of agreement betw een family caregivers and physicians on principal treatment goals. SUBJECTS AND METHODS: We surveyed family caregivers and physicians for 200 consecutive o lder adults who were initially evaluated at the outpatient geriatric assess ment center of a major teaching hospital. Treatment goals for patients were measured after a comprehensive geriatric assessment. RESULTS: Goals commonly chosen as most important by family caregivers and p hysicians pertained to day-to-day functioning (61 [31%] family caregivers, 81 [41%] physicians), behavior and emotional health (56 [28%] family caregi vers, 50 [25%] physicians), and safety (40 [20%] family caregivers, 29 [15% ] physicians). Although a substantial proportion of family caregiver and ph ysician pairs shared at least one goal (157 [79%] of 200), agreement on pre sence or absence of individual categories of goals was poor (kappas from -0 .19 to 0,28), and agreement on the most important goal was also poor (kappa 0.20). CONCLUSIONS: Agreement on treatment goals between family caregivers and phy sicians for patients at the study site was low. These results suggest that encounters between family caregiver and physician may need improvement. Fur ther research is needed to assess whether Lack of agreement is found in oth er settings, persists over time, acid affects achievement of goals and opti mal health outcomes. (C) 2001 by Excerpta Medica, Inc.