Vyjeyanthi S. Periyakoil|Eric Neri|Helena C. Kraemer
No Easy Talk: A Mixed Methods Study of Doctor Reported Barriers to Conducting Effective End-of-Life Conversations with Diverse Patients
Stanford University|VA Palo Alto Health Care System|Stanford University|Stanford University
though patients wish discuss endoflife eol issues doctors reluctant conduct endoflife conversations little known barriers doctors face conducting effective eol conversations diverse patients mixed methods study undertaken empirically identify barriers faced doctors conducting effective eol conversations diverse patients determine doctors age gender ethnicity medical subspecialty influenced barriers reportedmixedmethods study multispecialty doctors caring diverse seriously ill patients two large academic medical centers end training data collected 2010 2012doctorreported barriers eol conversations diverse patients1040 1234 potential subjects 843 participated 29 participants designated development cohort coding grounded theory analyses identify primary barriers codes validated analyses responses 50 randomly drawn subjects validation cohort n 996 doctors qualitative responses validation cohort coded analyzed using quantitative methods 001 doctors reported barriers conducting eol conversations patients 9999 doctors reported barriers 857 finding challenging conduct eol conversations patients especially patients whose ethnicity different asianamerican doctors reported struggles 913 followed african americans 853 caucasians 835 hispanic americans 793 conducting eol conversations patients biggest doctorreported barriers effective eol conversations language medical interpretation issues ii patientfamily religiospiritual beliefs death dying iii doctors ignorance patients cultural beliefs values practices iv patientfamilys cultural differences truth handling decision making v patients limited health literacy vi patients mistrust doctors health care system doctors ethnicity chisquare 1277 df 4 p 00125 medical subspecialty chisquare 1933 df 10 p 0036 influenced reported barriers friedmans test used examine participants relative ranking barriers across subgroups identified significant differences age group f statistic 3035 df 5 p 00001 medical subspecialty f statistic 1637 df 5 p 00001doctors report struggles conducting effective eol conversations patients especially whose ethnicity different vital identify strategies mitigate barriers doctors encounter conducting effective eol conversations seriously ill patients families