Survey on Clinician Perceptions and Practices Regarding Goals of Care Conversations.

Abstract

Early conversations between clinicians and patients about goals of care may improve patients' quality of life and prevent nonbeneficial care near the end of life, but these conversations are limited in frequency and scope. To address this issue, clinicians are increasingly asked to use standardized medical order forms, like the Medical Orders for Life-Sustaining Treatment (MOLST), to document end-of-life conversations and to help ensure that patients' wishes are realized. In kind, the Centers for Medicare and Medicaid Services recently decided to reimburse physicians as well as nurse practitioners and physician assistants for these conversations. To explore physicians' and advanced practitioners' (APs') attitudes and behaviors around initiating and documenting goals of care conversations and to identify targets for improvement. Online survey administered between October 1, 2014 and February 20, 2015. Physicians (n = 2492) and APs (n = 336) at an urban academic medical center. Clinicians' perceptions and self-reported behaviors regarding goals of care conversations and the Massachusetts MOLST form. We found that 44.0% of physicians and 33.0% of APs reported that they discussed goals of care with all patients with serious, life-limiting illness (p < 0.001). APs were more likely than physicians to report awareness of MOLST forms (55.1% vs. 45.1%, p < 0.001) but less likely to feel comfortable making recommendations on end-of-life care (25.3% vs. 41.0% recommending against resuscitation, p < 0.001; 35.1% vs. 55.7% recommending for resuscitation, p < 0.001). These findings suggest the need to educate physicians and empower APs to facilitate goals of care conversations and use standardized forms, as well as an opportunity for interdisciplinary collaboration.