Managing Bias in Palliative Care: Professional Hazards in Goals of Care Discussions at the End of Life

Callaghan, Katharine A.; Fanning, Joseph B.

doi:10.1177/1049909117707486

Cited by 13 publications

(11 citation statements)

References 32 publications

(72 reference statements)

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“…33 The discussions should not need to be significantly modified for cultural contexts as they should already be patient-centred. 34 Nonetheless, racial and cultural biases might be subconscious and could lead to misunderstandings about patient values, goals and preferences, 35 and all clinicians should be aware of the potential for bias. Although goals-of-care consultations are different from treatment limitation discussions, resuscitation status should be considered whenever goals-of-care change, with doctors explaining likely outcomes of life-sustaining therapies and making recommendations.…”

Section: Discussionmentioning

confidence: 99%

Review article: Goals‐of‐care discussions for adult patients nearing end of life in emergency departments: A systematic review

Hanning

Walker

Horrigan

et al. 2019

Emerg Medicine Australasia

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Goals-of-care discussions at end-oflife are associated with increased patient satisfaction and reduced treatment burdens, reduced family and healthcare worker distress and healthcare costs, while achieving equal life-expectancy. It is unclear how goals-of-care discussions should occur. The objective of the study was to determine which patients could benefit, requirements, content, documentation, and harms and benefits of emergency medicine goals-of-care discussions. We sought primary evidence on goals-of-care discussions in EDs with adult patients nearing end-oflife, published in English after 1989. Data sources included Medline, Embase, PsycINFO, CINAHL, Web of Science and reference lists of included articles. One thousand nine hundred and twenty abstracts were screened, five articles selected. There was no consensus on the meaning of goals-of-care, which is often confused with advanced care planning and treatment limitation. Emergency clinicians can identify most patients needing discussions following training. There was no evidence for how to involve stakeholders, nor how to adapt conversations to meet cultural and linguistically diverse needs. Expert panels have suggested requirements and content for conversations with little supporting evidence. There was no evidence for how emergency conversations differ to those in other settings, nor for harms or benefits for holding goals-of-care conversations in EDs. Increased ED goals-of-care conversations increased hospice referral and reduced in-patient admissions. Most studies were of moderate quality only, outcomes were not standardised and sample sizes were small. 'Goals-of-care' is used inconsistently across the literature. This is the first systematic review regarding goals-of-care discussions in EDs. Further research is needed on all aspects of these conversations.

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Section: Discussionmentioning

confidence: 99%

Review article: Goals‐of‐care discussions for adult patients nearing end of life in emergency departments: A systematic review

Hanning

Walker

Horrigan

et al. 2019

Emerg Medicine Australasia

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“…Despite the knowledge that decision aids contribute evidence to prevent variation in practice [5], minimise family con ict [8], and avoid clinicians biases in treatment recommendations during goals of care discussions [46], clinicians consulted during our pilot test were disinclined to use the comprehensive numeric prognostic information in routine care, while nurses found the quantitative prognostic information useful only if they could access by it before the interview with patients. Doctors were con dent in being up-to-date on clinical practice that did not require that level of detailed quantitative explanation for them or to patients.…”

Section: Discussionmentioning

confidence: 97%

Development and pilot testing of an electronic guide incorporating patient values and prognostic information in preparation for older people’s decision-making near the end of life.

Cardona

Lewis

Bannach-Brown

et al. 2022

Preprint

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Background To develop an electronic resource, called Communicating Health Alternatives Tool (CHAT) that was compatible with hospital medical records software to facilitate preliminary patient-centered decision-making across health settings for frail older adults with progressive chronic disease. Methods Mixed methods including literature review; user-directed specifications; web-based interface development with authentication, authorisation, and secure cloud services; clinician and consumer co-design, iterative user testing; and developer integration of feedback. Results An internet-based conversation guide to facilitate clinician-led advance care planning was co-developed covering screening for short-term risk of death, patient values and preferences, and treatment choices for chronic kidney disease and dementia. Printed summary of such discussion could be used to begin the process in hospital or community health services. Clinicians, patients, and caregivers were generally accepting of its contents and format and supported its use in routine clinical practice. Conclusion CHAT is anticipated to enhance clinicians’ confidence in initiating these sensitive but important discussions with their older patients near end of life. CHAT is available to health services for implementation in effectiveness trials of patient-centered care to determine whether the interaction and documentation leads to formal decision-making, goal-concordant care, and subsequent reduction of unwanted treatments at the end of life.

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“…Res. Public Health 2021, 18, 8081 2 of 15 of a "good death" of the patient or, as scholars pointed out, a "good enough death", which results from an adaptation of the original concept of "good death" [6].…”

Section: Introductionmentioning

confidence: 99%

“…These questions are the two sides of the same coin since the definition of the institutional conditions for the provision of palliative care outlines the ethical and cultural acceptance and legitimacy of palliative care. Wegleitner, Schuchter and Prieth [14] state that the above mentioned foundational principles of palliative care express the current prevalent ethical concerns in coping with the event of a death in the western world, while they may be questioned in other cultures [15][16][17][18][19]. Timmermanns proposes the notion of "death brokering" [2] (p. 993) to illustrate the "negotiation of culturally appropriate deaths" [ibidem].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Relationship between Practitioners and Caregivers during a Treatment of Palliative Care: A Grounded Theory of a Challenging Collaborative Process

Rossi

Crippa²,

Scaccabarozzi³

2021

IJERPH

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The possibility of coming to a “good death” is a challenging issue that crosses ethical and religious beliefs, cultural assumptions, as well as medical expertise. The provision of palliative care for relieving patients’ pain is a practice that reshapes the path to the event of death and gives form to a particular context of awareness, recalling the notion proposed by Glaser and Strauss. This decision redesigns the relationships between patients, practitioners and caregivers and introduces a new pattern of collaboration between them. Our study focuses on the implications of the collaboration between practitioners and caregivers, starting from the assumption that the latter may provide support to their loved ones and to the practitioners, but need to be supported too. We provide a qualitative analysis of this collaboration based on an empirical research that took place in four different settings of provision of palliative care, reporting the contrast between the affective engagement of caregivers and the professional approach of practitioners. We claim that this ambivalent collaboration, while embedded in contingent and incommensurable experiences, brings to the fore the broader understanding of the path to a “good death,” outlining its societal representation as a collective challenge.

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Managing Bias in Palliative Care: Professional Hazards in Goals of Care Discussions at the End of Life

Abstract: This is the first study identifying palliative care clinicians' biases and bias management strategies in end-of-life goals of care discussions.

Cited by 13 publications

References 32 publications

Review article: Goals‐of‐care discussions for adult patients nearing end of life in emergency departments: A systematic review

Review article: Goals‐of‐care discussions for adult patients nearing end of life in emergency departments: A systematic review

Development and pilot testing of an electronic guide incorporating patient values and prognostic information in preparation for older people’s decision-making near the end of life.

The Relationship between Practitioners and Caregivers during a Treatment of Palliative Care: A Grounded Theory of a Challenging Collaborative Process

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