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

    82967.pdf (1.207Mb)
    Access Status
    Open access
    Authors
    O'Connor, Moira
    Watts, K.J.
    Kilburn, W.D.
    Vivekananda, K.
    Johnson, C.E.
    Keesing, Sharon
    Halkett, Georgia
    Shaw, J.
    Colgan, V.
    Yuen, K.
    Jolly, R.
    Towler, S.C.
    Chauhan, A.
    Nicoletti, M.
    Leonard, A.D.
    Date
    2020
    Type
    Journal Article
    
    Metadata
    Show full item record
    Citation
    O’Connor, M. and Watts, K.J. and Kilburn, W.D. and Vivekananda, K. and Johnson, C.E. and Keesing, S. and Halkett, G.K.B. et al. 2020. A Qualitative Exploration of Seriously Ill Patients’ Experiences of Goals of Care Discussions in Australian Hospital Settings. Journal of General Internal Medicine. 35 (12): pp. 3572-3580.
    Source Title
    Journal of General Internal Medicine
    DOI
    10.1007/s11606-020-06233-y
    ISSN
    0884-8734
    Faculty
    Faculty of Health Sciences
    School
    Curtin School of Allied Health
    Curtin School of Nursing
    Remarks

    This is a post-peer-review, pre-copyedit version of an article published in Journal of General Internal Medicine. The final authenticated version is available online at: http://doi.org/10.1007/s11606-020-06233-y.

    URI
    http://hdl.handle.net/20.500.11937/82965
    Collection
    • Curtin Research Publications
    Abstract

    © 2020, Society of General Internal Medicine.

    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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