Are We Making Progress on Communication with People Who Are Near the End of Life in the Australian Health System? A Thematic Analysis

Trankle, Steven A; Shanmugam, Shantiban; Lewis, Ebony; Nicholson, Margaret; Hillman, Ken; Cardona, Magnolia

doi:10.1080/10410236.2018.1548335

Cited by 17 publications

(12 citation statements)

References 61 publications

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“…Another challenge to apply our findings involves the time required to engage in the complex and sensitive conversations that our participants described. Consistent with previous research, participants felt that time pressure poses a barrier to engaging in these conversations ( 24 , 25 ). They identified that in Australian primary healthcare, longer consultations are not as well remunerated as high-throughput medicine.…”

Section: Discussionsupporting

confidence: 74%

General practitioners’ practical approach to initiating end-of-life conversations: a qualitative study

et al. 2019

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Background As doctors who provide care across the life-course, general practitioners (GPs) play a key role in initiating timely end-of-life discussions. Nonetheless, these discussions are often not initiated until close to death. Given the ageing of the population, GPs will be confronted with end-of-life care more often, and this needs to become a core skill for all GPs. Objective To describe GPs’ approach to initiating end-of-life discussions. Methods Fifteen GPs or GP trainees from South-East Queensland, Australia, were purposively recruited to participate in a semi-structured interview. We analysed transcripts using a thematic analysis. Results GPs’ approach to initiating end-of-life discussions was summarized by four themes: (1) Preparing the ground; (2) finding an entry point; (3) tailoring communication and (4) involving the family. Conclusions Emphasis on the doctor–patient relationship; assessing patient readiness for end-of-life discussions; and sensitive information delivery is consistent with factors previously reported to be important to both GPs and patients in this context. Our findings provide a framework for GPs initiating end-of-life discussions, which must be tailored to patient and GP personality factors. Further research is required to evaluate its outcomes.

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Section: Discussionsupporting

confidence: 74%

General practitioners’ practical approach to initiating end-of-life conversations: a qualitative study

et al. 2019

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“…This research highlights that, in practice, recruitment to a rapid autopsy programme is both an art and a science, and certainly not a ‘one-size-fits-all’ scenario. 5,6 In general, it appears that the approaches taken by the CASCADE team are acceptable to patients who have consented to the programme.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 There is also recognition that end-of-life communication can be emotionally burdensome for practitioners and that there is not a one-size-fits-all approach to discussing a terminal prognosis with patients. 5,6 However difficult discussions can be successfully negotiated by developing trusting relationships and rapport with patients and their families.…”

Section: Introductionmentioning

confidence: 99%

The art and science of recruitment to a cancer rapid autopsy programme: A qualitative study exploring patient and clinician experiences

et al. 2020

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Background: CASCADE is a successful, Australia-first cancer rapid autopsy programme. Patients are recruited to the programme by their clinician once they understand that further treatment has only palliative intent. Despite its value, rapid autopsy is a rare research method owing partly to recruitment challenges. Aim: This research aimed to explore (1) how, in practice, clinicians select and recruit patients to the programme and (2) patient experiences of this process. Design: This was a qualitative study grounded in phenomenology. CASCADE team members (clinicians and researchers) and patients participated in semi-structured interviews. Data were analysed using an inductive, team-based approach to thematic analysis. Participants: Interviews were conducted with 31 participants (11 patients and 20 CASCADE team members). Results: Patient selection and recruitment to a rapid autopsy programme is both an art and science. In practice, patient selection is a subjective process that involves assessing a patient’s psychosocial suitability for the programme. Trust and rapport are necessary for informing this assessment and to create an environment conducive to discussing rapid autopsy. Clinicians have also crafted their own ways of delivering information about CASCADE, with both clinicians and patients acknowledging that, if not handled sensitively, recruitment could cause distress. Overall, patients were satisfied with the way in which they were recruited. Conclusion: Findings provide insight into how clinicians successfully select and recruit patients to a rapid autopsy programme and suggests that discussing such topics are acceptable to end-of-life patients. This research also raises thought-provoking questions about the ‘gatekeeping’ role of clinicians in recruitment.

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“…Engagement with, and completion of, ACP documents is influenced by cultural factors [6]. In Australia, ACP conversations can be emotionally challenging for both patients and practitioners but are of great value [7].…”

Section: Introductionmentioning

confidence: 99%

Communication of advance care planning decisions: a retrospective cohort study of documents in general practice

et al. 2020

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Background: Doctors, particularly general practitioners, play a significant role in assisting patients to create advance care plans. When medically indicated, these documents are important tools to promote congruence between endof-life care and patient's personal preferences. Despite this, little is known regarding the availability of these documents in hospitals. The aim of this study was to identify the proportion of people who died in hospital without an advance care plan and how many of these had advance care planning (ACP) documents in their general practice records. Methods: A retrospective cohort study was conducted of patient hospital records with manual linkage to general practice records. The large regional hospital in Victoria, Australia has a catchment population in excess of 300,000 people. The study sample was patients aged 75 years and over who died in the hospital between 1 January 2016 and 31 December 2017. The hospital records of these patients were examined to identify those which did not have a system alert for ACP documents on the file. Alerted ACP documents were limited to those legislated in the state of Victoria: advance care plan, Enduring Power of Attorney (Medical Treatment) or Enduring Power of Guardianship. Where no ACP document system alert was found in the hospital record, the patient's nominated general practice was consented to participate and the corresponding general practice record was examined. Data were analysed using descriptive statistics. Results: Of the 406 patients who died in hospital, 76.1% (309) did not have a system alert for any ACP document. Of the 309 hospital records without a system alert, 144 (46.7%) corresponding general practice records were examined. Of these, 14.6% included at least one ACP document, including four advance care plans, that were not available in hospital. Conclusions: Unless ACP documents are consistently communicated from general practice, patient's preferences may be unknown during end-of-life care. It is important that both doctors and patients are supported to use connected electronic health records to ensure that documents are readily available to healthcare staff when they are required.

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Are We Making Progress on Communication with People Who Are Near the End of Life in the Australian Health System? A Thematic Analysis

Cited by 17 publications

References 61 publications

General practitioners’ practical approach to initiating end-of-life conversations: a qualitative study

General practitioners’ practical approach to initiating end-of-life conversations: a qualitative study

The art and science of recruitment to a cancer rapid autopsy programme: A qualitative study exploring patient and clinician experiences

Communication of advance care planning decisions: a retrospective cohort study of documents in general practice

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