Strategies for effective goals of care discussions and decision-making: perspectives from a multi-centre survey of Canadian hospital-based healthcare providers.

Amanda L Roze Des Ordons,Nishan Sharma,John J You,Daren K Heyland

doi:10.1186/s12904-015-0035-x

Amanda L Roze Des Ordons, Nishan Sharma + Show 2 more

Open Access

https://doi.org/10.1186/s12904-015-0035-x

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Abstract

BackgroundCommunication gaps impact the quality of patient care. Previous research has focused on communication barriers rather than seeking solutions. Our aim was to identify strategies for effective communication and decision-making about goals of care for medical interventions in serious illness, from the perspectives of hospital-based healthcare providers.MethodsA cross-sectional survey composed of closed- and open-ended questions about goals of care communication and decision-making was administered to healthcare providers in 13 centres in six Canadian provinces. We analyzed a portion of the open-ended survey questions, specifically (1) suggestions for overcoming barriers encountered in discussing goals of care, and (2) currently effective practices. Thematic content analysis was used to analyze responses to the open-ended questions.ResultsOf the 1,256 respondents to the larger survey, 468 responded to the open-ended questions (37 %), including 272 of 512 nurses (53 %), 153 of 484 internal medicine trainees (32 %), and 43 of 260 attending physicians (17 %). Responses to each of the two questions were similar, generating a common set of themes and subthemes. Effective strategies and ideas for improving communication and decision-making about goals of care clustered under five themes: patient and family factors, communication between healthcare providers and patients, interprofessional collaboration, education, and resources. Subthemes highlighted core elements of shared decision-making.ConclusionsTranslating our findings into multifaceted interventions that consider patient and family factors, address knowledge gaps, optimize resource utilization, and facilitate communication and collaboration between patients, families and healthcare providers may improve communication and decision-making about goals of care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12904-015-0035-x) contains supplementary material, which is available to authorized users.

Highlights

Communication gaps impact the quality of patient care
Recognizing that effective initiatives to overcome perceived barriers can be found within a community itself, the objective of the current multicentre, cross-sectional survey was to elicit hospitalbased healthcare providers’ strategies for effective goals of care discussions and decision-making
Design and setting This cross-sectional study, conducted from September 2012 to March 2013, involved a self-administered questionnaire about effective goals of care communication and decision-making in relation to medical interventions desired in serious illness; it was distributed to hospitalbased clinicians in general internal medical teaching units (MTUs) at 13 academic centres in six Canadian provinces [18]

Summary

Introduction

Communication gaps impact the quality of patient care. Previous research has focused on communication barriers rather than seeking solutions. Our aim was to identify strategies for effective communication and decision-making about goals of care for medical interventions in serious illness, from the perspectives of hospital-based healthcare providers. Healthcare providers often do not discuss goals of care with seriously ill hospitalized patients [3, 4] or they. For seriously ill hospitalized patients, goals of care conversations include deliberation and decision-making about the use or non-use of lifesustaining treatments [12]. While many previous studies of EOL communication have focused on barriers [13, 14], a solutions-oriented focus can generate important. Recognizing that effective initiatives to overcome perceived barriers can be found within a community itself, the objective of the current multicentre, cross-sectional survey was to elicit hospitalbased healthcare providers’ strategies for effective goals of care discussions and decision-making. This study of healthcare provider experiences follows our previous exploration of patient and family perspectives on barriers and facilitators to advance care planning (the Audit of Communication, CarE Planning, and DocumenTation (ACCEPT) study [17]

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