Goals of care discussions in acute hospital admissions – Qualitative description of perspectives from patients, family and their doctors

Harris, Elly; Eng, Derek; Ang, Qi Kai; Clarke, Emily; Sinha, Atul

doi:10.1016/j.pec.2021.09.003

Cited by 9 publications

(34 citation statements)

References 56 publications

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“…Information provided to patients and or their relatives about their clinical condition, likely prognosis and benefits and burdens of life-sustaining and alternative treatments were explored in 26 articles [ 16 , 22 , 23 , 42 , 43 , 45 , 51 , 52 , 56 , 58 , 63 , 67 , 70 , 73 – 79 , 81 – 86 , 89 ]. Collective analysis of these papers yielded six sub-themes that related to (i) patient preconditions to receiving information, (ii) inconsistencies in information provision by a doctor to a patient (iii) personalisation of information, (iv) the role of decision aids, (v) patient understanding of information and (vi) consequences of being poorly or misinformed.…”

Section: Cmo One: Information Provided To Patients In a Personalised ...mentioning

confidence: 99%

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Examining how goals of care communication are conducted between doctors and patients with severe acute illness in hospital settings: A realist systematic review

Gross,

Koffman

2024

PLoS ONE

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Background Patient involvement in goals of care decision-making has shown to enhance satisfaction, affective-cognitive outcomes, allocative efficiency, and reduce unwarranted clinical variation. However, the involvement of patients in goals of care planning within hospitals remains limited, particularly where mismatches in shared understanding between doctors and patients are present. Aim To identify and critically examine factors influencing goals of care conversations between doctors and patients during acute hospital illness. Design Realist systematic review following the RAMESES standards. A protocol has been published in PROSPERO (CRD42021297410). The review utilised realist synthesis methodology, including a scoping literature search to generate initial theories, theory refinement through stakeholder consultation, and a systematic literature search to support program theory. Data sources Data were collected from Medline, PubMed, Embase, CINAHL, PsychINFO, Scopus databases (1946 to 14 July 2023), citation tracking, and Google Scholar. Open-Grey was utilized to identify relevant grey literature. Studies were selected based on relevance and rigor to support theory development. Results Our analysis included 52 papers, supporting seven context-mechanism-output (CMO) hypotheses. Findings suggest that shared doctor-patient understanding relies on doctors being confident, competent, and personable to foster trusting relationships with patients. Low doctor confidence often leads to avoidance of discussions. Moreover, information provided to patients is often inconsistent, biased, procedure-focused, and lacks personalisation. Acute illness, medical jargon, poor health literacy, and high emotional states further hinder patient understanding. Conclusions Goals of care conversations in hospitals are nuanced and often suboptimal. To improve patient experiences and outcome of care interventions should be personalised and tailored to individual needs, emphasizing effective communication and trusting relationships among patients, families, doctors, and healthcare teams. Inclusion of caregivers and acknowledgment at the service level are crucial for achieving desired outcomes. Implications for policy, research, and clinical practice, including further training and skills development for doctors, are discussed.

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Section: Cmo One: Information Provided To Patients In a Personalised ...mentioning

confidence: 99%

“…The patient’s or their family’s perception that the content discussed is considered to apply to them was an important prerequisite when engaging in any goals of care conversation [ 22 , 58 ]. This was particularly relevant for patients at the end-of-life.…”

Section: Cmo One: Information Provided To Patients In a Personalised ...mentioning

confidence: 99%

Examining how goals of care communication are conducted between doctors and patients with severe acute illness in hospital settings: A realist systematic review

Gross,

Koffman

2024

PLoS ONE

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“…Finally, multiple coders were used in this study, which is inconsistent with Guba and Lincoln's naturalistic inquiry approach [22]. However, this strategy was selected for three reasons: (1) to provide coding mentorship for a trainee with less qualitative research experience; (2) it is not uncommon for multiple coders to be employed within a qualitative description approach [31][32][33]; (3) despite its downsides, it remains a recognized approach for assuring credibility of study findings [23,34,35].…”

Section: Limitationsmentioning

confidence: 99%

Exploring participant perceptions of a virtually supported home exercise program for people with multiple myeloma using a novel eHealth application: a qualitative study

Purdy

Sobierajski

Onazi

et al. 2023

Support Care Cancer

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Introduction Supervision, tailoring, and flexibility have been proposed as key program elements for delivering successful exercise programs for people with multiple myeloma (MM). However, no studies to date have evaluated the acceptability of an intervention employing these components. The aim of this study was to determine the acceptability of a virtually supported exercise program and eHealth application for people with MM. Methods A qualitative description approach was used. One-on-one interviews were conducted with participants who completed the exercise program. Content analysis was used to analyze verbatim transcripts from interviews. Results Twenty participants were interviewed (64.9 ± 6.7 years of age, n = 12 females). Participants had positive perceptions of the exercise program. Two themes emerged related to strengths/limitations: One Size Does Not Fit All (sub-themes: Supportive & Responsive Programming and Diverse Exercise Opportunities ), and App Usability . Supportive and Responsive Programming was a main strength of the program, characterized as programming that was tailored, involved active support, and delivered by appropriate personnel. The inclusion of Diverse Exercise Opportunities was also regarded as a strength, as it accommodated the preferences of all participants. Related to App Usability, participants felt the app was simple and user friendly but had a few less intuitive components. Conclusion The virtually supported exercise program and eHealth application were acceptable for people with MM. Programs should employ tailoring, active support, and appropriate personnel to bolster acceptability and include both supervised and flexible exercise formats. eHealth apps should be simple to use so technology proficiency is not a barrier to participation. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-023-07762-y.

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“…Nurses provide health education tailored to patients' information needs. Evidence reveals that patients may feel difficulty comprehending disease-specific information provided by medical doctors [33]. Family members help patients in remembering or recalling information, giving information directly to the doctor, or clarifying instructions from the doctor so the patient can understand and seek necessary information [34].…”

Section: Conceptual Framework and Literature Reviewmentioning

confidence: 99%

The Effect of a Nurse-Led Family Involvement Program on Anxiety and Depression in Patients with Advanced-Stage Hepatocellular Carcinoma

et al. 2023

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Psychological distress is commonly reported in patients with advanced cancer. Family is considered a psychological supporter for patients during their cancer journey. This study aimed to examine the effect of a nurse-led family involvement program on anxiety and depression in patients with advanced hepatocellular cancer. This is a quasi-experimental study with a two-group, pre–post-test design. Forty-eight participants were recruited at a male medical ward in a university hospital in Southern Thailand, and assigned to either the experimental or the control group. The experimental group received the nurse-led family involvement program, while the control group received only conventional care. Instruments included a demographic data form, clinical data form, and the Hospital Anxiety and Depression Scale. Data analyses were performed using descriptive statistics, chi-square, Fisher’s exact test, and t-test. The results revealed that the mean scores of anxiety and depression in the experimental group at post-test were significantly lower than on the pretest and significantly lower than those of the control group. The results indicate that a nurse-led family involvement program has a short-term effect on the reduction of anxiety and depression in male patients with advanced HCC. The program can be useful for nurses to encourage family caregivers to engage in patient care during hospitalization.

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Goals of care discussions in acute hospital admissions – Qualitative description of perspectives from patients, family and their doctors

Cited by 9 publications

References 56 publications

Examining how goals of care communication are conducted between doctors and patients with severe acute illness in hospital settings: A realist systematic review

Examining how goals of care communication are conducted between doctors and patients with severe acute illness in hospital settings: A realist systematic review

Exploring participant perceptions of a virtually supported home exercise program for people with multiple myeloma using a novel eHealth application: a qualitative study

The Effect of a Nurse-Led Family Involvement Program on Anxiety and Depression in Patients with Advanced-Stage Hepatocellular Carcinoma

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