Why now
Evidence can list reasonable options. It cannot say which trade-offs a person should accept. Four places where that gap shows, and what Values in Care offers at each.
1. Value-based care
Payment is moving to outcomes. Someone has to say which outcomes count.
The gap: Value-based models reward results per dollar. Without the person's priorities, care can meet its targets and still deliver treatment the person did not want.
What Values in Care offers: A brief in the person's words names the outcomes that matter to them, so outcome-based care can aim at them.
Treatment-limiting POLST, yet intensive care
38%
1,162 decedents with comfort-only or limited-interventions POLSTs, hospitalized within 6 months of death, 2 hospitals, 2010-2017
Source: Lee et al., JAMA 2020 (PMID 32062674) · Data year 2010-2017
Source-checked2. Values in care
What matters is rarely asked, and often cut short.
The gap: Agendas go unasked, and care lines up better with some goals than others.
What Values in Care offers: Preparation before the visit, so the person arrives with their priorities and questions in their own words.
Time before a patient's concern was interrupted
11 seconds
27 of 40 recorded encounters where the agenda was elicited; it was elicited in 40 of 112 (36%)
Recordings come from shared decision-making trials, not a national sample.
Source: Singh Ospina et al., J Gen Intern Med 2019 (PMID 29968051) · Data year 2018
Source-checkedGoal-concordant care when the goal was comfort
51%
Outpatients with serious illness, multicenter trial enrollment surveys (405 with a prioritized goal); 86% when the goal was extending life
Source: Modes et al., J Pain Symptom Manage 2020 (PMID 32389606) · Data year 2020
Source-checked3. Values to care
A goal on file does not reliably shape the next decision.
The gap: Priorities are recorded in one place and lost at the next handoff, or never connected to the care that follows.
What Values in Care offers: A handoff the person controls: who decides, what to share, and a view for family, chaplain or clinician.
Seriously ill adults with goal-discordant care
39%
43 of 109 adults with 50% or higher predicted 6-month mortality, 3 urban hospitals, admitted 2019
Measured from clinical notes; 78% had at least one period where concordance was unclear.
Source: Auriemma et al., JAMA Netw Open 2025 (PMID 40608339) · Data year 2019
Source-checked4. Values, generally
People share what matters only where they trust.
The gap: Trust in physicians and hospitals has fallen. Disclosure depends on it.
What Values in Care offers: Nothing leaves the device unless the person chooses. Faith, culture and identity are never inferred.
Adults with a lot of trust in physicians and hospitals
40.1%
January 2024, down from 71.5% in April 2020; nonprobability internet survey with state quotas, 443,455 respondents
Source: Perlis et al., JAMA Netw Open 2024 (PMID 39083270) · Data year 2024
Source-checkedWhat this does not show
These figures describe the gap, mostly in serious illness, where the evidence is deepest. None of them shows that Values in Care closes it. Values in Care has not been evaluated with patients or care teams yet.