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"They Need to Have an Understanding of Why They're Coming Here and What the Outcomes Might Be." Clinician Perspectives on Goals of Care for Patients Discharged From Hospitals to Skilled Nursing Facilities.
Feder, Shelli L; Britton, Meredith Campbell; Chaudhry, Sarwat I.
Affiliation
  • Feder SL; Yale School of Nursing, West Haven, Connecticut, USA. Electronic address: shelli.feder@yale.edu.
  • Britton MC; Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
  • Chaudhry SI; Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
J Pain Symptom Manage ; 55(3): 930-937, 2018 03.
Article in En | MEDLINE | ID: mdl-29097273
CONTEXT: The number of patients discharged from acute care hospitals to skilled nursing facilities (SNFs) is rising. These patients have increasingly complex needs and many experience poor outcomes while under SNF care, including hospital readmissions. Patients' goals of care (GoC) are viewed as a factor contributing to unplanned hospital readmissions from SNFs. However, clinicians' perspectives of GoC for hospitalized patients discharged to SNFs are not well-described. OBJECTIVES: To explore how clinicians view GoC for hospitalized patients discharged to SNFs. METHODS: Qualitative study using semi-structured interviews and thematic analysis. RESULTS: Forty-one clinicians from one acute care hospital and two SNFs completed interviews ranging in length from 14 to 52 minutes (mean = 32 minutes). Of the sample, 22% were nurses, 20% physicians, 15% were from care management, and 15% were from social services. Respondents viewed patients' GoC for continuing treatment at the SNF as important, but acknowledged that they were infrequently discussed during hospitalization. Many respondents felt that patients and families had unrealistic GoC for SNF care. Factors that contributed to unrealistic GoC included patients' limited knowledge of disease processes, prognosis, and treatment options; and inconsistent or insufficient communication of GoC among hospital and SNF clinicians, the patient, and family members. Respondents associated a lack of GoC or unrealistic GoC with patients' dissatisfaction with SNF care, unplanned transitions to hospice, and hospital readmissions. CONCLUSIONS: Respondents reported that GoC conversations infrequently occurred during hospitalization, contributing to unrealistic patient and family expectations for SNF care and poor patient outcomes. Interventions are needed that facilitate timely, accurate, and consistent GoC discussions across care continuums.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Patient Care Planning / Patient Discharge / Skilled Nursing Facilities / Attitude of Health Personnel Type of study: Prognostic_studies / Qualitative_research Limits: Humans Language: En Journal: J Pain Symptom Manage Journal subject: NEUROLOGIA / PSICOFISIOLOGIA / TERAPEUTICA Year: 2018 Document type: Article Country of publication: United States

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Patient Care Planning / Patient Discharge / Skilled Nursing Facilities / Attitude of Health Personnel Type of study: Prognostic_studies / Qualitative_research Limits: Humans Language: En Journal: J Pain Symptom Manage Journal subject: NEUROLOGIA / PSICOFISIOLOGIA / TERAPEUTICA Year: 2018 Document type: Article Country of publication: United States