Exploring expanded interdisciplinary roles in goals of care conversations in a national goals of care initiative: A qualitative approach.
Palliat Med
; 35(8): 1542-1552, 2021 09.
Article
em En
| MEDLINE
| ID: mdl-34080488
ABSTRACT
BACKGROUND:
The United States Veterans Health Administration National Center for Ethics in Health Care implemented the Life-Sustaining Treatment Decisions Initiative throughout the Veterans Health Administration health care system in 2017. This policy encourages goals of care conversations, referring to conversations about patient's treatment and end-of-life wishes for life-sustaining treatments, among Veterans with serious illnesses. A key component of the initiative is expanding interdisciplinary provider roles in having goals of care conversations.AIM:
Use organizational role theory to explore medical center experiences with expanding interdisciplinary roles in the implementation of a goals of care initiative.DESIGN:
A qualitative thematic analysis of semi-structured interviews. SETTING/PARTICIPANTS:
Initial participants were recruited using purposive sampling of local medical center champions. Snowball sampling identified additional participants. Participants included thirty-one interdisciplinary providers from 12 geographically diverse initiative pilot and spread medical centers.RESULTS:
Five themes were identified. Expanding provider roles in goals of care conversations (1) involves organizational culture change; (2) is influenced by medical center leadership; (3) is supported by provider role readiness; (4) benefits from cross-disciplinary role agreement; and (5) can "overwhelm" providers.CONCLUSIONS:
Organizational role theory is a helpful framework for exploring interdisciplinary roles in a goals of care initiative. Support and recognition of provider role expansion in goals of care conversations was important for the adoption of a goals of care initiative. Actionable strategies, including multi-level leadership support and the use of interdisciplinary champions, facilitate role change and have potential to strengthen uptake of a goals of care initiative.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Veteranos
/
Comunicação
Tipo de estudo:
Prognostic_studies
/
Qualitative_research
Limite:
Humans
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article