Facilitators and Barriers to Oncologists’ Conduct of Goals of Care Conversations

Smith, Cardinale B.; Feder, Shelli; Bickell, Nina A.

doi:10.1177/0825859718777361

Cited by 28 publications

(41 citation statements)

References 18 publications

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“…This finding may reflect providerrelated barriers to GOC discussion such as hesitation to discuss GOC because of fear of causing distress or lack of time. 8,21 System-level barriers such as delay in obtaining records from other hospitals and patient-related barriers such as patients' mental incapacity and delay in contacting surrogate decision makers are some of the other possible explanations for this finding.…”

Section: Discussionmentioning

confidence: 99%

Association Between the Timing of Goals-of-Care Discussion and Hospitalization Outcomes in Patients With Metastatic Cancer

Emiloju

Djibo

Ford

2019

Am J Hosp Palliat Care

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Background: Patients with cancer often require acute hospitalizations, many of which are unplanned. These hospitalizations have been shown to increase in frequency near the end of life. The American College of Physicians recommends that goals-of-care (GOC) discussions be initiated early for metastatic cancers. We hypothesized that discussing GOC during hospitalization could help reduce readmissions. Our aim was to examine the association between the timing of GOC discussion, length of hospital stay, and the time to readmission. Methods: We conducted a retrospective review of medical records of patients with stage IV cancers hospitalized between August 2017 and July 2018. We recorded timing of GOC discussion, use of palliative care services, and hospital readmissions within 90 days. χ2 tests were used to identify independent associations with GOC discussion, and logistic regression was used to examine association with readmission within 90 days. Results: Of all study patients (N = 241), 40.6% were female, 46% (n = 112) had a GOC discussion, and 34% (n = 82) had a palliative care consultation. Having a palliative care consult and being admitted to critical care were independently associated with having a GOC discussion. Early timing of GOC discussion was inversely associated with admission to critical care units ( P < .05). Thirty-eight percent (n = 92) had unplanned hospital readmission within 90 days. Having a GOC discussion was independently associated with a reduction in the odds of an unplanned hospital readmission within 90 days by 79% (odds ratio = 0.21, 95% confidence interval: 0.12-0.37). Conclusion: Among hospitalized patients with stage IV cancer, performing an early GOC discussion has an important association with lower hospital readmission rates and increased rates of goal-congruent patient care.

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Section: Discussionmentioning

confidence: 99%

Association Between the Timing of Goals-of-Care Discussion and Hospitalization Outcomes in Patients With Metastatic Cancer

Emiloju

Djibo

Ford

2019

Am J Hosp Palliat Care

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“…In addition, a balance must be reached between overcoming one's fears and being able to confidently approach the pluridimensional reality of someone who knows his end is coming. 32,33 Limitations With regard to the study's limitations, we consider the possibility that the personal positions of the researchers may have biased the results. To counter this problem, we have in our favor the ultimate motivation of this work-understanding so as to improve rather than merely demonstrate-and we can also note the method of rigorous analysis used in this investigation.…”

Section: Discussionmentioning

confidence: 99%

Competence and Compassion: Key Elements of Professional Care at the End of Life From Caregiver’s Perspective

Ortega‐Galán

Fernández

Carmona-Rega

et al. 2018

Am J Hosp Palliat Care

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In the act of caring for and helping people in the end-of-life process, the professional who provides care and assistance must know how to maintain a relationship of closeness, empathy, and compassion for the pain and suffering of the person who is going to die. The objective was to understand, elaborate on, and characterize the key elements of end-of-life care of patients from a caregiver's perspective through a qualitative phenomenological multicenter study. Participants were caregivers who had lost a family member at least 2 months but less than 2 years in the past. The techniques used were 5 discussion groups and 41 in-depth interviews, which included a total of 81 participants. To analyze the information, a protocol developed by Giorgi was followed. Two dimensions or units of meaning, with subdimensions, emerged: (1) Technical competence, with the subdimensions "Control of symptoms" and "Continuity of care," and (2) Compassion, with the subdimensions "Effective/affective communication," "Attitudes of kindness and closeness toward the patient and the family," and "Generosity and personalized flexibility of care." Assistance at the end of life requires the proper preparation of professionals who care for these patients, in addition to a compassionate attitude on the part of professionals and the people accompanying the dying person, that fosters a more humanized and dignified treatment in the dying process.

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“…20 Many studies pointed out that the lack of goals of care conversations were related to difficulty predicting prognosis and identifying when and how goals of care conversations should occur, healthcare providers' limited time and lack of training necessary to discuss goals of care, and lack of willingness to discuss goals of care among both patients and providers. 19,20,24 The absence of goals of care conversations before referral to hospice inhibits appropriate decisionmaking about patients' end-of-life wishes, preferences, and quality of life.…”

Section: Main Findings Of the Studymentioning

confidence: 99%

“…Much of the previous research works on the perspectives of goals of care discussion were conducted in clinical settings or long-term care facilities and have relied on healthcare providers' perspectives. [19][20][21]23 On the other hand, this study was conducted with a small number of persons with heart failure and family caregivers due to the acuity of persons receiving hospice care and the nature of home-based settings. Further research is needed to focus on the voices and perspectives of persons with heart failure and family caregivers.…”

Section: Strengths and Limitations Of The Studymentioning

confidence: 99%

Building trust and facilitating goals of care conversations: A qualitative study in people with heart failure receiving home hospice care

et al. 2020

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Background: Despite a majority of persons receiving hospice care in their homes, there are gaps in understanding how to facilitate goals of care conversations between persons with heart failure and healthcare providers. Aim: To identify barriers and facilitators which shape goals of care conversations for persons with heart failure in the context of home hospice. Design: A qualitative descriptive study design was used with semi-structured interviews. Setting/participants: We conducted qualitative interviews with persons with heart failure, family caregivers, and interprofessional healthcare team members at a large not-for-profit hospice agency in New York City between March 2018 and February 2019. Results: A total of 39 qualitative interviews were conducted, including with healthcare team members (e.g. nurses, physicians, social workers, spiritual counselors), persons with heart failure, and family caregivers. Three themes emerged from the qualitative interviews regarding facilitators and barriers in goals of care conversations for better decision-making: (1) trust is key to building and maintaining goals of care conversations; (2) lack of understanding and acceptance of hospice inhibits goals of care conversations; and (3) family support and engagement promote goals of care conversations. Conclusion: Findings from this study suggest that interventions designed to improve goals of care conversations in the home hospice setting should focus on promoting understanding and acceptance of hospice, family support and engagement, and building trusting relationships with interprofessional healthcare teams.

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Facilitators and Barriers to Oncologists’ Conduct of Goals of Care Conversations

Abstract: GoC conversations may be facilitated by enabling oncologists to conduct these conversations despite difficult circumstances and emotional reactions by activating patients and family via increased health literacy and by advancing palliative-informed practice environments.

Cited by 28 publications

References 18 publications

Association Between the Timing of Goals-of-Care Discussion and Hospitalization Outcomes in Patients With Metastatic Cancer

Association Between the Timing of Goals-of-Care Discussion and Hospitalization Outcomes in Patients With Metastatic Cancer

Competence and Compassion: Key Elements of Professional Care at the End of Life From Caregiver’s Perspective

Building trust and facilitating goals of care conversations: A qualitative study in people with heart failure receiving home hospice care

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