Communicating end-of-life care goals and decision-making among a multidisciplinary geriatric inpatient rehabilitation team: A qualitative descriptive study

Abstract

Background:In geriatric inpatient rehabilitation settings, where the goal is to optimise function, providing end-of-life care can be challenging.Aim:The aim of this study is to explore how end-of-life care goals and decision-making are communicated in a geriatric inpatient rehabilitation setting.Design:The design is a qualitative descriptive design using semi-structured individual and group interviews.Setting/participants:This study was conducted in a 154-bed facility in metropolitan Melbourne, Australia, providing geriatric inpatient rehabilitation for older patients; medical, nursing and allied health clinicians, who had cared for an inpatient who died, were recruited.Data collection:Participants were interviewed using a conversational approach, guided by an ‘aide memoire’.Results:A total of 19 clinicians participated in this study, with 12 interviewed individually and the remaining 7 clinicians participating in group interviews. The typical patient was described as older, frail and with complex needs. Clinicians described the challenge of identifying patients who were deteriorating towards death, with some relying on others to inform them. How patient deterioration and decision-making was communicated among the team varied. Communication with the patient/family about dying was expected but did not always occur, nor was it always documented. Some clinicians relied on documentation, such as commencement of a dying care pathway to indicate when a patient was dying.Conclusion:Clinicians reported difficulties recognising patient deterioration towards death. Uncertainty and inconsistent communication among clinicians about patient deterioration negatively impacted team understanding, decision-making, and patient and family communication. Further education for all members of the multidisciplinary team focusing on how to recognise and communicate impending death will aid multidisciplinary teams to provide quality end-of-life care when required.

Placing the Preferences of People with Profound Intellectual and Multiple Disabilities At the Center of End-of-Life Decision Making Through Storytelling

“…Despite the importance of ensuring end-of-life care wishes and preferences are known and communicated, there is widespread reluctance among individuals, family, and health professionals to talk about end-of-life treatment preferences, dying, death, and associated existential concerns (Bloomer et al, 2018; Brazil et al, 2017; George et al, 2016). Even when it is evident that death is inevitable, health professionals report significant challenges in communicating about dying and discussing end-of-life care preferences with patients and others (Bloomer et al, 2018; Bloomer, Lee, & O’Connor, 2011; George et al, 2016).…”

“…Despite the importance of ensuring end-of-life care wishes and preferences are known and communicated, there is widespread reluctance among individuals, family, and health professionals to talk about end-of-life treatment preferences, dying, death, and associated existential concerns (Bloomer et al, 2018; Brazil et al, 2017; George et al, 2016). Even when it is evident that death is inevitable, health professionals report significant challenges in communicating about dying and discussing end-of-life care preferences with patients and others (Bloomer et al, 2018; Bloomer, Lee, & O’Connor, 2011; George et al, 2016). When a person’s capacity to contribute to discussions is questioned, as it may be for people with PIMD, challenges in communication between caregivers, surrogates, and supported decision-makers about care decisions may arise (Bloomer, Digby, Tan, Crawford, & Williams, 2016; Bloomer & Digby, 2012; Quinn, Gur, & Watson, 2018).…”

“…In 2015, the ACSQHC recognized the importance of addressing the provision of end-of-life care in hospitals, correlating with increased empirical focus on end-of-life communication and planning in Australia and internationally (Anderson, Bloch, Armstrong, Stone, & Low, 2019; Turner & Flemming, 2019). Other research has examined the needs and care provision for highly vulnerable groups, such as older people (Bloomer et al, 2018; Bloomer et al, 2019b; Witham & Hockley, 2016) and those from culturally and linguistically diverse backgrounds (Bloomer et al, 2019a; Johnstone, Hutchinson, Redley, & Rawson, 2015). Yet, little attention has been paid to such planning in the lives of people with intellectual disability, including people with PIMD.…”

End-of-Life Care

“…Older people want an opportunity to discuss their preferences, including for their end-of-life care, but few are afforded the opportunity to do so while they are able (Weathers et al 2016). Hence, timely discussions and formal recording of the care preferences for older people, particular before dementia impacts their ability to express preferences, is essential (Bamford et al 2018;Bloomer et al 2018).…”

Looking Forward: Research to Respond to a Rapidly Aging Population

“…As people age, end-of-life considerations become more significant as prospects of a not too distant death looms. In the case for aging peers who have not lived with severe disability, it is often put off because of discomfort or undertaken so late that there is uncertainty about how to capture last wishes (Bloomer et al, 2018). Such uncertainty is especially strong with regard to persons who communicate in ways other than words.…”