Concordance between expressed preferences and documented goals
| Patients | Family members | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Preferences* | Documented goals* | Preferences* | Documented goals* | ||||||||||
| 1 | 2 | 3 | 4 | 5 | Total | 1 | 2 | 3 | 4 | 5 | Total | ||
| 1 | 56 | 0 | 7 | 1 | 28 | 92 | 1 | 34 | 0 | 8 | 3 | 31 | 76 |
| 2 | 26 | 3 | 34 | 3 | 7 | 73 | 2 | 4 | 5 | 15 | 1 | 32 | 57 |
| 3 | 20 | 3 | 74 | 8 | 36 | 141 | 3 | 8 | 1 | 33 | 4 | 46 | 92 |
| 4 | 34 | 8 | 85 | 16 | 51 | 194 | 4 | 15 | 3 | 58 | 32 | 75 | 183 |
| Total | 136 | 14 | 200 | 28 | 122 | 500 | Total | 61 | 9 | 114 | 40 | 184 | 408 |
| Agreement=35.4% | Agreement=33.1% | ||||||||||||
| Medical error rate: Total=36.4% Potential undertreatment:1.6% Potential overtreatment:34.8% Potential overtreatment in patients preferring ‘comfort’ only: 6.8% | Medical error rate; Total=46.8% Potential undertreatment: 2.7% Potential overtreatment: 44.1% Potential overtreatment in family members preferring ‘comfort’ only: 3.7% | ||||||||||||
| κ=0.20 | κ=0.29 | ||||||||||||
| Weighted κ=0.30 | Weighted κ=0.39 | ||||||||||||
*Taxonomy of documented goals is as follows:
1. All possible life-sustaining treatments including cardiopulmonary resuscitation (CPR).
2. Different degrees of life-sustaining treatments but no CPR.
3. Full medical care, no CPR.
4. Use of comfort measures.
5. No documented goals of care order.
Agreement: the percentage of patients/family members whose preferences and their documented goals are the same or whose preferences are #1 and there are no documented goals of care order. The cells highlighted in yellow are included in this calculation. For this calculation, we omitted patients which expressed uncertainty about their preferred goals of care.
Medical error rate: These are the most extreme areas of discordance and thus considered a medical error. Undertreatment is calculated by considering the percentage of patients/family members whose preferences are #1 (for CPR) and their documented goals are #2, #3 or #4 (withheld CPR). Potential overtreatment is when expressed preferences are #2, #3 or #4 (no CPR) and their documented goals are #1 or there are no documented goals of care order (will receive CPR). Potential overtreatment in patients preferring ‘comfort’ only is when patient/family express a preference for #4 (comfort measures only) and they are ordered to receive CPR (#1).