Vyjeyanthi S. Periyakoil|Eric Neri|Helena C. Kraemer
No Easy Task: A Mixed Methods Study of Barriers to Conducting Effective End-Of-Life Conversations Reported by Multi-Specialty Doctors (S776)
Palo Alto University|Stanford University|Stanford University|Palo Alto University|Stanford University
gain initial understanding current state gap patients desire discuss endoflife issues doctors often reluctant soidentify top six barriers conducting effective endoflife conversations diverse patients familiesgain initial understanding clinicians age ethnicity gender subspecialty may impact care provide though patients wish discuss endoflife eol issues doctors reluctant conduct eol conversations identify barriers doctors face conducting eol conversations diverse patients determine doctors age gender ethnicity subspecialty influenced barriers reported mixed methods study doctors caring diverse seriously ill patients two large academic medical centers end training 1040 1234 potential subjects 843 participated 29 participants designated development cohort qualitative analyses using grounded theory methods identify primary barriers codes validated analyzing responses 50 randomly drawn subjects validation cohort n996 doctors 001 doctors denied barriers conducting eol conversations patients 9999 doctors reported barriers 857 finding challenging conduct eol conversations especially patients whose ethnicity different asianamerican doctors reported struggles 913 followed africanamericans 853 caucasians 835 hispanicamericans 793 barriers included languagemedical interpretation issues patientfamily religiospiritual beliefs doctors ignorance patients cultural values patientfamilys cultural differences truth handling decision making limited health literacy patients mistrust doctors doctors ethnicity chisquare1277 df4 p00125 medicalsubspecialty chisquare1933 df10 p0036 influenced reported barriers friedmans test used examine ranking barriers across subgroups identified significant differences age f statistic3035 df5 p00001 medical subspecialty f statistic1637 df5 p00001 doctors struggle conducting effective eol conversations especially patients whose ethnicity different