A Qualitative Exploration of Seriously Ill Patients’ Experiences of Goals of Care Discussions in Australian Hospital Settings
© 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 pr...
| Main Authors: | , , , , , , , , , , , , , , |
|---|---|
| Format: | Journal Article |
| Language: | English |
| Published: |
SPRINGER
2020
|
| Subjects: | |
| Online Access: | http://hdl.handle.net/20.500.11937/82965 |
| _version_ | 1848764550999965696 |
|---|---|
| author | O'Connor, Moira Watts, K.J. Kilburn, W.D. Vivekananda, K. Johnson, C.E. Keesing, Sharon Halkett, Georgia Shaw, J. Colgan, V. Yuen, K. Jolly, R. Towler, S.C. Chauhan, A. Nicoletti, M. Leonard, A.D. |
| author_facet | O'Connor, Moira Watts, K.J. Kilburn, W.D. Vivekananda, K. Johnson, C.E. Keesing, Sharon Halkett, Georgia Shaw, J. Colgan, V. Yuen, K. Jolly, R. Towler, S.C. Chauhan, A. Nicoletti, M. Leonard, A.D. |
| author_sort | O'Connor, Moira |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | © 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. |
| first_indexed | 2025-11-14T11:21:09Z |
| format | Journal Article |
| id | curtin-20.500.11937-82965 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| language | English |
| last_indexed | 2025-11-14T11:21:09Z |
| publishDate | 2020 |
| publisher | SPRINGER |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-829652021-10-12T00:05:46Z A Qualitative Exploration of Seriously Ill Patients’ Experiences of Goals of Care Discussions in Australian Hospital Settings O'Connor, Moira Watts, K.J. Kilburn, W.D. Vivekananda, K. Johnson, C.E. Keesing, Sharon Halkett, Georgia Shaw, J. Colgan, V. Yuen, K. Jolly, R. Towler, S.C. Chauhan, A. Nicoletti, M. Leonard, A.D. Science & Technology Life Sciences & Biomedicine Health Care Sciences & Services Medicine, General & Internal General & Internal Medicine goals of care communication preferences patients internal medicine OF-LIFE CARE LONG-TERM OUTCOMES HEALTH-CARE EFFECTIVE COMMUNICATION DECISION-MAKING END BARRIERS PHYSICIANS FAMILIES ILLNESS © 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. 2020 Journal Article http://hdl.handle.net/20.500.11937/82965 10.1007/s11606-020-06233-y English SPRINGER fulltext |
| spellingShingle | Science & Technology Life Sciences & Biomedicine Health Care Sciences & Services Medicine, General & Internal General & Internal Medicine goals of care communication preferences patients internal medicine OF-LIFE CARE LONG-TERM OUTCOMES HEALTH-CARE EFFECTIVE COMMUNICATION DECISION-MAKING END BARRIERS PHYSICIANS FAMILIES ILLNESS O'Connor, Moira Watts, K.J. Kilburn, W.D. Vivekananda, K. Johnson, C.E. Keesing, Sharon Halkett, Georgia Shaw, J. Colgan, V. Yuen, K. Jolly, R. Towler, S.C. Chauhan, A. Nicoletti, M. Leonard, A.D. A Qualitative Exploration of Seriously Ill Patients’ Experiences of Goals of Care Discussions in Australian Hospital Settings |
| title | A Qualitative Exploration of Seriously Ill Patients’ Experiences of Goals of Care Discussions in Australian Hospital Settings |
| title_full | A Qualitative Exploration of Seriously Ill Patients’ Experiences of Goals of Care Discussions in Australian Hospital Settings |
| title_fullStr | A Qualitative Exploration of Seriously Ill Patients’ Experiences of Goals of Care Discussions in Australian Hospital Settings |
| title_full_unstemmed | A Qualitative Exploration of Seriously Ill Patients’ Experiences of Goals of Care Discussions in Australian Hospital Settings |
| title_short | A Qualitative Exploration of Seriously Ill Patients’ Experiences of Goals of Care Discussions in Australian Hospital Settings |
| title_sort | qualitative exploration of seriously ill patients’ experiences of goals of care discussions in australian hospital settings |
| topic | Science & Technology Life Sciences & Biomedicine Health Care Sciences & Services Medicine, General & Internal General & Internal Medicine goals of care communication preferences patients internal medicine OF-LIFE CARE LONG-TERM OUTCOMES HEALTH-CARE EFFECTIVE COMMUNICATION DECISION-MAKING END BARRIERS PHYSICIANS FAMILIES ILLNESS |
| url | http://hdl.handle.net/20.500.11937/82965 |