Confidence with and Barriers to Serious Illness Communication: A National Survey of Hospitalists.
J Palliat Med
; 20(9): 1013-1019, 2017 09.
Article
en En
| MEDLINE
| ID: mdl-28375816
ABSTRACT
OBJECTIVE:
To describe the concerns, confidence, and barriers of practicing hospitalists around serious illness communication.BACKGROUND:
Hospitalist physicians are optimally positioned to provide primary palliative care, yet their experiences in serious illness communication are not well described.METHODS:
Web-based survey, conducted in May 2016. The survey link was distributed via email to 4000 members of the Society of Hospital Medicine. The 39-item survey assessed frequency of concerns about serious illness communication, confidence for common tasks, and barriers using Likert-type scales. It was developed by the authors based on prior work, a focus group, and feedback from pilot respondents.RESULTS:
We received 332 completed surveys. On most or every shift, many participants reported having concerns about a patient's or family's understanding of prognosis (53%) or the patient's code status (63%). Most participants were either confident or very confident in discussing goals of care (93%) and prognosis (87%). Fewer were confident or very confident in responding to patients or families who had not accepted the seriousness of an illness (59%) or in managing conflict (50%). Other frequently cited barriers were lack of time, lack of prior discussions in the outpatient setting, unrealistic prognostic expectations from other physicians, limited institutional support, and difficulty finding records of previous discussions.DISCUSSION:
Our results suggest opportunities to improve hospitalists' ability to lead serious illness communication by increasing the time hospitalists have for discussions, improving documentation systems and communication between inpatient and outpatient clinicians, and targeted training on challenging communication scenarios.Palabras clave
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Cuidados Paliativos
/
Índice de Severidad de la Enfermedad
/
Barreras de Comunicación
/
Médicos Hospitalarios
Tipo de estudio:
Prognostic_studies
/
Qualitative_research
Límite:
Adult
/
Humans
/
Middle aged
Idioma:
En
Revista:
J Palliat Med
Asunto de la revista:
SERVICOS DE SAUDE
Año:
2017
Tipo del documento:
Article