Nurse Communication About Goals of Care.

Elaine Wittenberg, Phd,Tammy Neiman, Ms, Rn-Bc,Haley Buller, Ms,Joy Goldsmith, Phd,Betty

doi:10.6004/jadpro.2016.7.2.2

Abstract

Conversations about goals of care with the patient and family are a critical component of advanced practice in oncology. However, there are often inadequate team structures, training, or resources available to assist advanced practitioners in initiating these conversations. We conducted a study to assess nurses' perceived role and communication tasks in such conversations about goals of care. In a cross-sectional survey of 109 nurses attending a comprehensive 2-day end-of-life nursing education course, nurses were asked to describe how they would participate in a "goals of care" meeting in three different scenarios. They were also asked what changes they desired in their clinical settings. Nurses overwhelmingly described that their primary task and communication role was to assess patient/family understanding. Nurses referenced their team members and team support with the least frequency across scenarios. Team roles, structure, and process were reported as areas in greatest need of change in patient/family goals of care meetings. These findings demonstrate that lack of preparation to function as a team is a barrier for nurses in communicating about goals of care, and there is a demand to move such conversations upstream in oncology care.

Highlights

A difficult conversation has been defined as an interaction between a provider and a patient at transition points on the disease trajectory (Svarovsky, 2013)
Goals-of-care conversations need to include trained advanced practitioners (APs) and target patients at high risk of death within the year, few APs have received formal communication training about these discussions, and hospital systems rarely have processes in place to ensure that these conversations take place
Given the emphasis on nurse communication skills to determine the goals and preferences of patients and families and assist with health-care decision-making (National Consensus Project for Quality Palliative Care, 2013), this study explored nurses’ perception of their role and communication tasks during goalsof-care conversations with patients and family in three different contexts

Summary

Introduction

A difficult conversation has been defined as an interaction between a provider and a patient at transition points on the disease trajectory (Svarovsky, 2013) In oncology, these transition points include sharing a new cancer diagnosis, deciding on treatment options, transitioning to survivorship, or shifting the focus to palliative care. These transition points include sharing a new cancer diagnosis, deciding on treatment options, transitioning to survivorship, or shifting the focus to palliative care These conversations, commonly known as “goals-of-care” discussions, often involve family and provide a platform for discussing and setting goals of care and sustaining hope by defining and reevaluating goals as the patient’s disease progresses (Svarovsky, 2013). This article summarizes the literature on goals-of-care conversations and presents a study on nurses’ perception of these conversations

Methods

Discussion

Conclusion