Discussing care decisions at the internal medicine outpatient clinic: A conversation analysis

Briede, Saskia; Charldorp, T.C. van; Kaasjager, Karin A H

doi:10.1016/j.pec.2021.11.029

Cited by 7 publications

(4 citation statements)

References 17 publications

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“…Briedé et al . [ 19 ] reported that only 3.1% of the consultations at the internal outpatient clinic involved discussions of future care, increasing to 17.6% after receiving training on the importance of discussing preferences for care. Briedé et al .…”

Section: Discussionmentioning

confidence: 99%

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Finding the balance between person-centred and treatment-centred discussions in advance care planning—a qualitative analysis of conversations within the MUTUAL (Multidisciplinary Timely Undertaken Advance Care Planning conversations) intervention using a narrative analysis

van Lummel,

Ietswaard,

Rigter

et al. 2024

Age and Ageing

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Introduction Advance care planning (ACP) aims to create conditions for more person-centred care. We aimed to explore variations in person-centred care discussions and treatment-centred care discussions within ACP conversations in the Multidisciplinary Timely Undertaken Advance Care Planning (MUTUAL) intervention and how person-centred care discussions could be encouraged. The MUTUAL intervention consists of the following: (i) timely patient selection, (ii) the patient and healthcare professionals preparing for the conversation, (iii) a scripted ACP conversation in a multidisciplinary setting and (iv) documentation. Methods We conducted a narrative analysis of ACP conversations. A narrative summary template was created and used to analyse 18 audio-recordings. Results We noticed variations in person-centred and treatment-centred focus within the ACP conversations. We identified three important strategies that facilitated person-centred care discussions within ACP conversations. First, healthcare professionals’ acceptance that ACP is an individual process. We believe it is important that healthcare professionals recognise and accept where the patient is in his or her individual ACP process; not making decisions right away can also be part of a decisional process. Secondly, exploring the underlying motivation for treatment wishes can give insights into patient’s wishes, values and needs. Lastly, healthcare professionals who demonstrated an adaptive, curious and engaged attitude throughout the ACP process achieved more person-centred ACP conversations. This coincided with elaborating on the patient’s emotions, fears and worries. Conclusion Person-centred and treatment-centred focus varied within the ACP conversations in the MUTUAL intervention. Certain strategies by healthcare professionals facilitated a more person-centred focus.

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Section: Discussionmentioning

confidence: 99%

“…Briedé et al . [ 19 ] suggest that listening actively and carefully to the patient and encouraging them to speak and form their own conclusions should be encouraged.…”

Section: Discussionmentioning

confidence: 99%

Finding the balance between person-centred and treatment-centred discussions in advance care planning—a qualitative analysis of conversations within the MUTUAL (Multidisciplinary Timely Undertaken Advance Care Planning conversations) intervention using a narrative analysis

van Lummel,

Ietswaard,

Rigter

et al. 2024

Age and Ageing

View full text Add to dashboard Cite

show abstract

“…Ahluwalia et al showed that physicians missed the majority of opportunities (84%) to engage in ACP when analysing whether physicians engaged in ACP during regular outpatient clinic visits when a patient expressed concerns, questions and thoughts regarding their future care [ 16 ]. Briedé et al reported that only 3.1% of the consultations at the internal outpatient clinic involved discussions of future care [ 17 ]. This increased to 17.6% after physicians received training on the importance of care decision conversations and training with simulated patients [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

“…Briedé et al reported that only 3.1% of the consultations at the internal outpatient clinic involved discussions of future care [ 17 ]. This increased to 17.6% after physicians received training on the importance of care decision conversations and training with simulated patients [ 17 ]. Second, several barriers for hospital physicians to engage in ACP exist, including lack of communication skills, lack of knowledge concerning ACP, lack of time, cultural differences and fear of medico-legal repercussions [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

The development and feasibility study of Multidisciplinary Timely Undertaken Advance Care Planning conversations at the outpatient clinic: the MUTUAL intervention

Lummel

Savelkoul²,

Stemerdink³

et al. 2022

BMC Palliat Care

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Background Patients still receive non-beneficial treatments when nearing the end of life. Advance care planning (ACP) interventions have shown to positively influence compliance with end of life wishes. Hospital physicians seem to miss opportunities to engage in ACP, whereas patients visiting the outpatient clinic usually have one or more chronic conditions and are at risk for medical emergencies. So far, implemented ACP interventions have had limited impact. Structural implementation of ACP may be beneficial. We hypothesize that having ACP conversations more towards the end of life and involving the treating physician in the ACP conversation may help patient wishes and goals to become more concrete and more often documented, thus facilitating goal-concordant care. Aim To facilitate timely shared decision making and increase patient autonomy we aim to develop an ACP intervention at the outpatient clinic for frail patients and determine the feasibility of the intervention. Methods The United Kingdom’s Medical Research Council framework was used to structure the development of the ACP intervention. Key elements of the ACP intervention were determined by reviewing existing literature and an iterative process with stakeholders. The feasibility of the developed intervention was evaluated by a feasibility study of 20 ACP conversations at the geriatrics and pulmonology department of a non-academic hospital. Feasibility was assessed by analysing evaluation forms by patients, nurses and physicians and by evaluating with stakeholders. A general inductive approach was used for analysing comments. The developed intervention was described using the template for intervention description and replication (TIDieR). Results We developed a multidisciplinary timely undertaken ACP intervention at the outpatient clinic. Key components of the developed intervention consist of 1) timely patient selection 2) preparation of patient and healthcare professional 3) a scripted ACP conversation in a multidisciplinary setting and 4) documentation. 94.7% of the patients, 60.0% of the nurses and 68.8% of the physicians agreed that the benefits of the ACP conversation outweighed the potential burdens. Conclusion This study showed that the developed ACP intervention is feasible and considered valuable by patients and healthcare professionals.

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Childbirth as Fault Lines: Justifications in Physician–Patient Interactions About Postnatal Rehabilitation

Li,

Tian,

Meng

et al. 2024

Health Care Anal

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Discussing care decisions at the internal medicine outpatient clinic: A conversation analysis

Cited by 7 publications

References 17 publications

Finding the balance between person-centred and treatment-centred discussions in advance care planning—a qualitative analysis of conversations within the MUTUAL (Multidisciplinary Timely Undertaken Advance Care Planning conversations) intervention using a narrative analysis

Finding the balance between person-centred and treatment-centred discussions in advance care planning—a qualitative analysis of conversations within the MUTUAL (Multidisciplinary Timely Undertaken Advance Care Planning conversations) intervention using a narrative analysis

The development and feasibility study of Multidisciplinary Timely Undertaken Advance Care Planning conversations at the outpatient clinic: the MUTUAL intervention

Childbirth as Fault Lines: Justifications in Physician–Patient Interactions About Postnatal Rehabilitation

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