Defining priorities for improving end-of-life care in Canada

Heyland, Daren K.; Cook, Deborah J.; Rocker, Graeme; Dodek, Peter; Kutsogiannis, Demetrios J; Skrobik, Yoanna; Jiang, Xuran; Day, Andrew G.; Cohen, S. Robin

doi:10.1503/cmaj.100131

Cited by 130 publications

(163 citation statements)

References 26 publications

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“…Recent studies provide insights into patient and family member perspectives on communication about goals of care in advanced HF,3, 4, 11, 12 but comparatively little is known about the perspective of cardiology clinicians. Before designing and evaluating interventions to improve decision‐making about goals of care for patients with advanced HF, an understanding of clinicians' perceived barriers is needed so that interventions can be tailored to overcome these barriers 17.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have provided insights into the perspectives of seriously ill hospitalized patients with HF, and their families, and have identified that EOL communication and decision‐making are important to patients and families, but their needs related to these issues remain unmet 3, 4, 11, 12. Before developing tailored solutions to improve communication and decision‐making about goals of care for hospitalized patients with advanced HF, there is a need to also understand the barriers and facilitators to this process from clinicians' perspectives.…”

Section: Introductionmentioning

confidence: 99%

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Barriers to goals of care discussions with hospitalized patients with advanced heart failure: feasibility and performance of a novel questionnaire

et al. 2016

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AimsGood end‐of‐life communication and decision‐making are important to patients with advanced heart failure (HF) and their families, but their needs remain unmet. In this pilot study, we describe the feasibility and performance of a novel questionnaire aimed at identifying barriers and solutions to improve communication and decision‐making about goals of care for hospitalized patients with advanced HF.MethodsWe distributed questionnaires to staff cardiologists, cardiology trainees, and cardiology nurses who provide care for HF patients at a Canadian teaching hospital. The questionnaire asked about the importance of various barriers to goals of care discussions. It also asked participants to rank their willingness to engage in goals of care discussions and their views on other clinicians could engage in such discussions.ResultsOf 76 clinicians, 44 (58%) completed the questionnaire (median completion time, 17 min). Individual survey questions had few missing responses (0% to 2%) for questions about barriers to goals of care discussions. There was appreciable discrimination of the importance of different barriers (mean scores 2.2 to 6.0 on a 7‐point scale). Preliminary data suggest that clinicians perceive patient and family factors, such as difficulty accepting a poor prognosis, as the most important barriers preventing goals of care discussions.ConclusionsIn this pilot study, we have demonstrated the feasibility of a novel questionnaire to be used in a larger multi‐centre study of end‐of‐life HF care. Essential information will be obtained to inform the design and evaluation of interventions that seek to improve communication and decision‐making about goals of care with HF patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Barriers to goals of care discussions with hospitalized patients with advanced heart failure: feasibility and performance of a novel questionnaire

et al. 2016

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“…Patients in hospital with serious illness and their family members have identified improvements in end-of-life communication and decision-making as high-priority targets for quality improvement; 4,5 however, hospital-based health care providers infrequently engage patients and families in such conversations. 6 Accordingly, the focus of our review is to provide guidance for advance care planning as it pertains to the inpatient setting (i.e., determination of goals of care for the patient in hospital).…”

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confidence: 99%

Just ask: discussing goals of care with patients in hospital with serious illness

You

Fowler

Heyland

2013

CMAJ

105

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CMAJ, April 1, 2014, 186(6) 425 O ur population is aging, and older patients are living longer with chronic illness. Technology-laden end-of-life care is associated with poorer quality of life, lower satisfaction with care and increased anxiety and depression for family members.1 Ad vance care planning can increase the quality of life of dying patients, improve the experience of family members and decrease health care costs. 1-3Advance care planning is a process by which patients consider options for future health care decisions and identify their wishes. These decisions and wishes can vary depending on the setting. For example, during an acute stay in hospital, the plan may pertain to the goals of care for the current stay in addition to any care that may be required after discharge. In other settings, the plan may result in an advance care directive -a verbal or written instruction de scribing what kind of care a patient would want (or not want) if he or she were no longer able to speak for him or herself, and the values that guide the patient in making important health care decisions. Advance care planning may also result in the nomination of a substitute decision-maker -someone who makes decisions for the pa tient if the patient is incapable of doing so.Patients in hospital with serious illness and their family members have identified improvements in end-of-life communication and decision-making as high-priority targets for quality improvement; 4,5 however, hospital-based health care providers infrequently engage patients and families in such conversations.6 Accordingly, the focus of our review is to provide guidance for advance care planning as it pertains to the inpatient setting (i.e., determination of goals of care for the patient in hospital). Although health care providers in the outpatient setting (e.g., family physicians, consultant physicians) play a key role in advance care planning, hospital-based providers share this responsibility. In fact, a stay in hospital presents an important opportunity for engaging in discussions about goals of care, because it signals a change in the trajectory of the patient's illness, giving in creased relevance to these conversations, and because potential substitute decision-makers (e.g., the most involved family members) are often present.To organize our review, we use a communication and decision-making framework consisting of the following components: identifying patients at high risk of dying who need to have a discussion about goals of care; information exchange (regarding prognosis, values, and the risks and expected outcomes of various treatment options); and reaching a decision through discussion and deliberation.7 By providing structured guidance, specific advice and practical tools, our aim is to increase clinicians' confidence in engaging in meaningful end-of-life communication with patients in hospital and their family members. To inform this review, we drew on a broad range of evidence, from expert opinion to randomized controlled trials and systematic...

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“…Engaging patients and their families in advance care planning may well be the single most important thing we can do as a society to improve the quality of end-of-life care [1][2][3][4][5][6]. In the absence of effective advance care planning, patients may receive unwanted and unnecessary care at the end of life at a significant cost to families and society.…”

Section: Introductionmentioning

confidence: 99%

Advance Directives in Patients Over 60 Years Old: Assessment of Perceived Value and Need For Education in the Outpatient Setting

Alshanberi¹,

Tallant²,

Huddleston³

et al. 2018

Arch Med

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Defining priorities for improving end-of-life care in Canada

Cited by 130 publications

References 26 publications

Barriers to goals of care discussions with hospitalized patients with advanced heart failure: feasibility and performance of a novel questionnaire

Barriers to goals of care discussions with hospitalized patients with advanced heart failure: feasibility and performance of a novel questionnaire

Just ask: discussing goals of care with patients in hospital with serious illness

Advance Directives in Patients Over 60 Years Old: Assessment of Perceived Value and Need For Education in the Outpatient Setting

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