Serious disease conversation-promoting interventions have proven promise in advancing high-quality care. In contrast, some individuals in randomized studies could gain more from the intervention than others. For a study, researchers sought to investigate treatment impact heterogeneity and identify patient subgroups with severe illnesses who would benefit most from measures to improve communication about treatment objectives.

In order to boost goals-of-care talks in the outpatient environment, they used data from a multi-center cluster-randomized experiment testing a communication intervention. Patients had significant illnesses with an anticipated median survival of two years (n = 249 intervention, n = 288 conventional care). In addition, they examined the heterogeneity of the intervention’s impact on the frequency of patient-reported goals-of-care discussions, the documentation of goals-of-care discussions in electronic health records, patient ratings of communication quality, and patient symptoms of psychological distress at 3 and 6 months using model-based recursive partitioning.

They discovered two important interactions. Patients with higher household incomes had a favorable intervention impact for their overall assessment of clinician communication (n = 251), while patients with lower incomes did not (P<0.001). When it came to patients’ depressive symptoms at 6 months (n = 288), the intervention was linked to fewer symptoms in those with poor self-reported health but not in those with fair to outstanding health (P<0.001).

After the randomized study was over, it was helpful to identify treatment effect heterogeneity. Patient income and self-reported health were shown to interact with the intervention in ways that imply these variables may be utilized to better communicate treatment objectives.