Clinicians’ accounts of communication with patients in end-of-life care contexts: A systematic review

Scholz, Brett; Goncharov, Liza; Emmerich, Nathan; Lu, Vinh Nhat; Chapman, Michael; Clark, Shannon; Wilson, Tracey; Slade, Diana; Mitchell, Imogen

doi:10.1016/j.pec.2020.06.033

Cited by 35 publications

(28 citation statements)

References 90 publications

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“…57 These barriers are reinforced by clinicians' implicit biases toward and unfamiliarity with Asian cultural nuances during EOL conversations. 58,59 Thus, an examination of the pattern of use and effectiveness of palliative care among Asian Americans may be important in exposing inequities in palliative care access and engagement. Finally, at the policy level, several forces may contribute to the sustained differences in EOL care intensity for Asian Americans.…”

Section: Discussionmentioning

confidence: 99%

Asian American Medicare Beneficiaries Disproportionately Receive Invasive Mechanical Ventilation When Hospitalized at the End-of-Life

et al. 2021

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Section: Discussionmentioning

confidence: 99%

Asian American Medicare Beneficiaries Disproportionately Receive Invasive Mechanical Ventilation When Hospitalized at the End-of-Life

et al. 2021

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“…16 Communicating with patients in intensive care units (ICUs) and their families poses challenges, as the environment may be frightening, and patients are usually admitted due to serious, sometimes unexpected, illnesses and injuries. 17,18 It is essential to listen to them, answer their questions, and understand their preferences in order to make them feel safer and help them maintain some sense of control and autonomy, which decreases stress and anxiety and increases satisfaction with healthcare. 3,19,20 Another demanding context involves communication with patients and families regarding diseases without therapeutic perspectives and/or end-of-life.…”

Section: Introductionmentioning

confidence: 99%

Quality of Communication Questionnaire for Patients Hospitalized in Intensive and Palliative Care: Validity Evidence for Use in Brazil

Castanhel

Burg

Nogueira

et al. 2021

Am J Hosp Palliat Care

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The Quality of Communication Questionnaire (QoC) was culturally adapted for Brazil due to its importance and use in several studies and different scenarios. The objective of this study was to evaluate the validity evidence of the Brazilian version of the QoC. A validation study was carried out involving 253 patients admitted to five public hospitals in Southern Brazil. Data were analyzed using descriptive analysis, Cronbach's alpha (α) to assess internal consistency, exploratory factor analysis, and goodness-of-fit index. One hundred and three patients were in intensive care (IC), and 150 were in palliative care (PC). The participants’ mean age was 51 years (SD = 14.2). QoC,and its general communication subscale, and end-of-life communication subscale means were 5.5 (SD = 1.6), 8.8 (SD = 1.5), and 5.5 (SD = 1.6) respectively. Among patients in IC, QoC Cronbach’s alpha was .75, and .84 in the general communication subscale and .51 in the end-of-life communication subscale. Among patients in PC, QoC Cronbach’s alpha was .83, and .88 in the general communication subscale, and .71 in the end-of-life communication subscale. The root mean square error of approximation was .07 (90% CI: .04 – .08); Tucker-Lewis index was .97 (95% CI: .95 – .98); comparative fit index was .98 (95% CI: .97 – .99), and χ2/df ratio was 1.33 (χ2[53] = 70.858, p = .05). The authors conclude that the general communication subscale of QoC Brazilian version has good validity evidence for patients in IC and PC, whereas the end-of-life communication subscale is only valid for patient in PC.

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“…The overall late referral (especially for the site that did not have an onsite specialist palliative care team) does not allow patients to be afforded the benefits of timely referral to specialist palliative care. 5…”

Section: Discussionmentioning

confidence: 99%

“…2 Providing optimal end-of-life care in such settings is challenging. 3 A complex range of factors contribute to suboptimal end-of-life care, including failure to identify patients in their last months of life, 4 poor communication regarding prognosis with patients and families, 5 and failure to establish clear goals of care between members of professional teams, 6 which gives rise to inadequate provision of palliative interventions such as pain relief, 7 and delivery of inappropriate and futile investigations and treatments. 8 The Australian Commission on Safety and Quality in Health Care undertook a program of work reviewing the safety and quality of end-of-life care in acute hospitals.…”

Section: Introductionmentioning

confidence: 99%

Understanding end-of-life care in Australian hospitals

et al. 2021

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ObjectiveTo explore end-of-life care in the ward and intensive care unit (ICU) environment in nine Australian hospitals in a retrospective observational study. MethodsIn total, 1693 in-hospital deaths, 356 in ICU, were reviewed, including patient demographics, advance care plans, life-sustaining treatments, recognition of dying by clinicians and evidence of the palliative approach to patient care. ResultsMost patients (n = 1430, 84%) were aged ≥60 years, with a low percentage (n = 208, 12%) having an end-of-life care plan on admission. Following admission, 82% (n = 1391) of patients were recognised as dying, but the time between recognition of dying to death was short (ICU (staying 4–48 h) median 0.34 days (first quartile (Q1), third quartile (Q3): 0.16, 0.72); Ward (staying more than 48 h) median 2.1 days (Q1, Q3: 0.96, 4.3)). Although 41% (n = 621) patients were referred for specialist palliative care, most referrals were within the last few days of life (2.3 days (0.88, 5.9)) and 62% of patients (n = 1047) experienced active intervention in their final 48 h. ConclusionsLate recognition of dying can expose patients to active interventions and minimises timely palliative care. To attain alignment to the National Consensus Statement to improve experiences of end-of-life care, a nationally coordinated approach is needed. What is known about the topic?The majority of Australian patient deaths occur in hospitals whose care needs to align to the Australian Commission on Safety and Quality in Health Care’s National Consensus Statement, essential elements of safe and high-quality end-of-life care. What does this paper add?The largest Australian study of hospital deaths reveals only 12% of patients have existing advance care plans, recognition of death is predominantly within the last 48 h of life, with 60% receiving investigations and interventions during this time with late symptom relief. What are the implications for practitioners?Given the poor alignment with the National Consensus Statement, a nationally coordinated approach would improve the patient experience of end-of-life care.

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Clinicians’ accounts of communication with patients in end-of-life care contexts: A systematic review

Cited by 35 publications

References 90 publications

Asian American Medicare Beneficiaries Disproportionately Receive Invasive Mechanical Ventilation When Hospitalized at the End-of-Life

Asian American Medicare Beneficiaries Disproportionately Receive Invasive Mechanical Ventilation When Hospitalized at the End-of-Life

Quality of Communication Questionnaire for Patients Hospitalized in Intensive and Palliative Care: Validity Evidence for Use in Brazil

Understanding end-of-life care in Australian hospitals

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