John J. You|James Downar|Robert Fowler|François Lamontagne|W. Y. Irene|Dev Jayaraman|Jennifer Kryworuchko|Patricia H. Strachan|Roy Ilan|Aman P. Nijjar|John Neary|John Shik|Kevin Brazil|Amen Patel|Kim Wiebe|Martin Albert|Anita Palepu|Élysée Nouvet|Amanda Roze des Ordons|Nishan Sharma|Amane Abdul?Razzak|Xuran Jiang|Andrew G. Day|Daren K. Heyland
Barriers to Goals of Care Discussions With Seriously Ill Hospitalized Patients and Their Families
McMaster University|University of Toronto|Sunnybrook Health Science Centre|Health Sciences Centre|University of Toronto|Centre Hospitalier Universitaire de Sherbrooke|Université de Sherbrooke|University of Calgary|McGill University|University of Saskatchewan|McMaster University|Queen's University|University of British Columbia|McMaster University|Memorial University of Newfoundland|Queen's University Belfast|McMaster University|University of Manitoba|Hôpital du Sacré-Cœur de Montréal|Université de Montréal|University of British Columbia|McMaster University|University of Calgary|University of Calgary|University of Calgary|Kingston General Hospital|Clinical Evaluation Research Unit|Kingston General Hospital|Clinical Evaluation Research Unit|Kingston General Hospital|Clinical Evaluation Research Unit|Queen's University
seriously ill hospitalized patients identified communication decision making goals care high priorities quality improvement endoflife care interventions improve care likely succeed tailored existing barriersto determine perspective hospitalbased clinicians 1 barriers impeding communication decision making goals care seriously ill hospitalized patients families 2 willingness acceptability clinicians engage processmulticenter survey medical teaching units nurses internal medicine residents staff physicians participating units 13 universitybased hospitals 5 canadian provincesimportance 21 barriers goals care discussions rated 7point scale 1 extremely unimportant 7 extremely importantbetween september 2012 march 2013 questionnaires returned 1256 1617 eligible clinicians overall response rate 777 512 646 nurses 793 484 634 residents 763 260 337 staff physicians 772 following family memberrelated patientrelated factors consistently identified 3 clinician groups important barriers goals care discussions family members patients difficulty accepting poor prognosis mean sd score 58 12 56 13 respectively family members patients difficulty understanding limitations complications lifesustaining treatments 58 12 groups disagreement among family members goals care 58 12 patients incapacity make goals care decisions 56 12 clinicians perceived skills system factors less important barriers participants viewed acceptable clinician groups engage goals care discussionsincluding role advance practice nurses nurses social workers initiate goals care discussions decision coachhospitalbased clinicians perceive family memberrelated patientrelated factors important barriers goals care discussions health care professionals viewed playing important roles addressing goals care findings inform design future interventions improve communication decision making goals care