A Qualitative Exploration of Seriously Ill Patients’ Experiences of Goals of Care Discussions in Australian Hospital Settings
MetadataShow full item record
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.
© 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.
Showing items related by title, author, creator and subject.
A systematic review on the factors affecting effective communication between registered nurses and oncology adult patients in the inpatient settingTay, L.; Hegney, Desley; Ang, E. (2010)Background: Effective nurse-patient communication is essential in the development of therapeutic relationships and meeting the cognitive and affective needs of oncology patients. However, the emotional load in cancer ...
Factors affecting effective communication between registered nurses and adult cancer patients in an inpatient setting: a systematic reviewLi, H.; Hegney, Desley; Ang, E. (2011)Aim: To establish the best available evidence regarding the factors affecting effective communication between registered nurses and inpatient cancer adults. Method: Electronic databases (CINAHL, Ovid, PubMed, ScienceDirect, ...
Advance care planning uptake among patients with severe lung disease: A randomised patient preference trial of a nurse-led, facilitated advance care planning interventionSinclair, C.; Auret, K.; Evans, S.; Williamson, F.; Dormer, S.; Wilkinson, A.; Greeve, K.; Koay, A.; Price, D.; Brims, Fraser (2017)Objective Advance care planning (ACP) clarifies goals for future care if a patient becomes unable to communicate their own preferences. However, ACP uptake is low, with discussions often occurring late. This study assessed ...