Patient-Centered Measures of Goal Concordance in Geriatrics and Palliative Care: A Scoping Review.

Importance: Goal concordance underpins high-quality care for patients with serious illness and older adults with multimorbidity and geriatric syndromes; however, a criterion standard for measurement is lacking.

Objective: To identify and describe patient- and caregiver-reported measures of goal concordance for patients with serious illness, geriatric syndromes, and multimorbidity to create a conceptual model of goal-concordance measurement.

Evidence Review: This scoping review included an electronic search across MEDLINE, Embase, Web of Science Core Collection, the CINAHL, and PsycINFO through September 2024. Search terms included goals, priorities, preferences, value, expectations, concordance, discordance, match, attain, achieve, align, congruence, dissonance, respect, and terms related to multimorbidity, geriatric syndromes, and serious illness. The review included randomized clinical trials and quasiexperimental, observational, cohort, cross-sectional, mixed methods, quality-improvement, and qualitative studies, plus secondary analyses that either included a patient- and/or caregiver-reported measure of goal concordance as an outcome or as part of a measure development or validation study. Two reviewers extracted data and resolved disagreements via discussion. Study and measure characteristics were summarized and cross-tabulated to identify measurement framework patterns and to propose a conceptual model of measurement.

Findings: Of 4801 articles screened, 664 full-text articles were assessed for eligibility. A total of 63 studies met inclusion criteria, yielding 67 measures; 44 measures were unique. Most studies were secondary data analyses (17 studies [27.0%]) and included patients with serious illness (44 studies [69.8%]). Measures used 7 of 10 available goal concordance frameworks, with most adopting framework 7 (40 measures [59.7%]), which matched patient preference for an outcome with degree of desired outcome achievement. Four framework components were identified and used to create a conceptual model for goal-concordance measurement: (1) patient preference for an outcome or treatment, (2) treatment undergone or treatment intention, (3) degree of treatment alignment with preference, and (4) degree of desired outcome achievement.

Conclusions And Relevance: This scoping review of patient- and caregiver-reported measures of goal concordance for patients with serious illness, geriatric syndromes, and multimorbidity describes existing measurement frameworks and proposes a conceptual model of measurement that can be used to guide future goal-concordance measure development in geriatrics and palliative care.