“I Just Felt Like I Was Stuck in the Middle”: Physician Assistants' Experiences Communicating With Terminally Ill Patients and Their Families in the Acute Care Setting

Abstract

Context Terminally ill hospitalized patients and their families consistently rank effective communication and shared decision-making among their top priorities. Advance Practice Providers such as Physician Assistants (PAs) are increasingly providing care in the hospital setting and are often called to communicate with patients and families. A first step to improving PA communication is to better understand PAs’ current experiences in their daily practices. Objectives This study aimed to explore: 1) roles PAs serve in communicating with terminally ill patients/families; 2) PAs’ attitudes and opinions about communication roles and 3) perceived barriers and facilitators of communication with patients/families in the hospital setting. Methods Five focus groups were conducted with PAs practicing on adult medical services at three acute care hospitals of an academic medical center in the Bronx, NY. An open-ended question guide was used. An inductive thematic analysis strategy was used to examine the data from transcribed audiotapes of focus group sessions to identify emergent concepts and themes. Results The overarching theme that emerged was being Stuck in the Middle. PAs experienced 1) ambiguity around their roles and responsibilities in communications between the medical team and patients and families; 2) gaps in knowledge and skills and 3) organizational or structural deficits in the patient care systems that placed them in uncomfortable situations. Conclusion Interventions aimed at improving PA communication with terminally ill patients and their families should target institutional structures, systems and culture around roles and responsibilities in addition to skill and knowledge gaps in order to be most effective.

Gaps in Hospice and Palliative Care Research: A Scoping Review of the North American Literature

“…Studies discussing research gaps under the clinical theme comprised 56% of all papers found ( n = 14) [ 12 , 15 , 17 – 21 , 23 , 26 , 27 , 30 , 31 , 33 , 35 ].…”

“…Another gap in the clinical elements of HPC/EoL pertains to the subtheme of overall training and education that healthcare providers and palliative healthcare providers received (32%, n = 8) [ 12 , 15 , 18 – 20 , 23 , 27 , 35 ]. For example, five studies reported that healthcare providers expressed uncertainty in communicating with patients as they experienced gaps in knowledge, skills, and training [ 12 , 15 , 18 , 31 , 35 ]. As well, there were differences in the amount of HPC training each healthcare provider received, with some having more knowledge on end-of-life issues than others [ 15 , 23 , 27 ].…”

“…For example, five studies reported that healthcare providers expressed uncertainty in communicating with patients as they experienced gaps in knowledge, skills, and training [ 12 , 15 , 18 , 31 , 35 ]. As well, there were differences in the amount of HPC training each healthcare provider received, with some having more knowledge on end-of-life issues than others [ 15 , 23 , 27 ]. Healthcare providers felt that the gaps in education and training limited their ability to communicate with patients.…”

“…Each of the themes discussed related to gaps that need to be addressed in different areas of research in HPC/EoL. While the theme of clinical gaps remained among the most prominent throughout the articles included ( n = 14, 56%) [ 12 , 15 , 17 – 21 , 23 , 26 , 27 , 30 , 31 , 33 , 35 ], access to care—specifically access for minority or marginalized populations—was another important topic [ 12 , 17 , 26 , 33 ]. Some issues regarding gaps in research methodology were a lack of funding, adequate sample sizes, and data availability.…”

“…The studies reviewed also highlighted gaps in levels of training received by those working in palliative care settings and in healthcare/healthcare administration in general [ 12 , 15 , 17 – 19 , 26 , 27 , 31 , 33 , 35 ]. In order to standardize and provide the best care for patients, a palliative care competency framework should be considered as guidelines on education for healthcare providers specifically for practitioners dealing with different cultural groups.…”