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01-12-2020 | Care | Original Research

A Qualitative Exploration of Seriously Ill Patients’ Experiences of Goals of Care Discussions in Australian Hospital Settings

Authors: Moira O’Connor, PhD, Kaaren J. Watts, PhD, Warren D. Kilburn, MEd&DevPsych, Kitty Vivekananda, PhD, Claire E. Johnson, PhD, Sharon Keesing, PhD, Georgia K. B. Halkett, PhD, Josephine Shaw, MPsych, Valerie Colgan, MSc (Nurse Education), Kevin Yuen, MBBS, FAChPM, Renate Jolly, BSc (Nursing), Simon C. Towler, FCICM, FANZCA, FACHSM, FAMA, Anupam Chauhan, MBBS MD FCICM, Margherita Nicoletti, MBBS, FAChPM, Anton D. Leonard, MB BCH BAO BA MPhil FCICM FANZCA MRCPI

Published in: Journal of General Internal Medicine | Issue 12/2020

Abstract

Background

Goals of care (GOC) is a communication and decision-making process that occurs between a clinician and a patient (or surrogate decision-maker) during an episode of care to facilitate a plan of care that is consistent with the patient’s preferences and values. Little is known about patients’ experiences of these discussions.

Objective

This study explored patients’ perspectives of the GOC discussion in the hospital setting.

Design

An explorative qualitative design was used within a social constructionist framework.

Participants

Adult patients were recruited from six Australian hospitals across two states. Eligible patients had had a GOC discussion and they were identified by the senior nurse or their doctor for informed consent and interview.

Approach

Semi-structured individual or dyadic interviews (with the carer/family member present) were conducted at the bedside or at the patient’s home (for recently discharged patients). Interviews were audio-recorded and transcribed verbatim. Data were analysed for themes.

Key Results

Thirty-eight patient interviews were completed. The key themes identified were (1) values and expectations, and (2) communication (sub-themes: (i) facilitators of the conversation, (ii) barriers to the conversation, and (iii) influence of the environment). Most patients viewed the conversation as necessary and valued having their preferences heard. Effective communication strategies and a safe, private setting were facilitators of the GOC discussion. Deficits in any of these key elements functioned as a barrier to the process.

Conclusions

Effective communication, and patients’ values and expectations set the stage for goals of care discussions; however, the environment plays a significant role. Communication skills training and education designed to equip clinicians to negotiate GOC interactions effectively are essential. These interventions must also be accompanied by systemic changes including building a culture supportive of GOC, clear policies and guidelines, and champions who facilitate uptake of GOC discussions.

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Title: A Qualitative Exploration of Seriously Ill Patients’ Experiences of Goals of Care Discussions in Australian Hospital Settings
Authors: Moira O’Connor, PhD
Kaaren J. Watts, PhD
Warren D. Kilburn, MEd&DevPsych
Kitty Vivekananda, PhD
Claire E. Johnson, PhD
Sharon Keesing, PhD
Georgia K. B. Halkett, PhD
Josephine Shaw, MPsych
Valerie Colgan, MSc (Nurse Education)
Kevin Yuen, MBBS, FAChPM
Renate Jolly, BSc (Nursing)
Simon C. Towler, FCICM, FANZCA, FACHSM, FAMA
Anupam Chauhan, MBBS MD FCICM
Margherita Nicoletti, MBBS, FAChPM
Anton D. Leonard, MB BCH BAO BA MPhil FCICM FANZCA MRCPI
Publication date: 01-12-2020
Publisher: Springer International Publishing
Keyword: Care
Published in: Journal of General Internal Medicine / Issue 12/2020
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-020-06233-y

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