Highlights
- •Clinicians see patient/family factors as key barriers to goals-of-care discussions.
- •Clinicians should expect these conversations to be difficult for patients/families.
- •Clinicians need more education and tools to enable them to have these conversations.
- •There is opportunity for an interprofessional approach to goals-of-care discussions.
Abstract
Background
Conversations about goals of care in hospital are important to patients who have advanced
heart failure (HF).
Methods
We conducted a multicenter survey of cardiology nurses, fellows, and cardiologists
at 8 Canadian teaching hospitals. The primary outcome was the importance of barriers
to goals-of-care discussions in hospital (1 = extremely unimportant; 7 = extremely
important). We also elicited perspectives on roles of different practitioners in having
these conversations.
Results
Questionnaires were returned by 770/1024 (75.2%) eligible clinicians. The most important
perceived barriers were: family members' and patients' difficulty in accepting a poor
prognosis (mean [SD] score 5.9 [1.1] and 5.7 [1.2], respectively), family members'
and patients' lack of understanding about the limitations and harms of life-sustaining
treatments (5.8 [1.1] and 5.7 [1.2], respectively), and lack of agreement among family
members about goals of care (5.8 [1.2]). Interprofessional team members were viewed
as having different but important roles in goals-of-care discussions.
Conclusions
Cardiology clinicians perceive family and patient-related factors as the most important
barriers to goals-of-care discussions in hospital. Many members of the interprofessional
team were viewed as having important roles in addressing goals of care. These findings
can inform the design of future interventions to improve communication about goals
of care in advanced HF.
Key Words
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Article info
Publication history
Published online: June 22, 2017
Accepted:
June 15,
2017
Received in revised form:
June 11,
2017
Received:
January 30,
2017
Footnotes
Funding: This work was supported by a grant from the Heart and Stroke Foundation, Ontario Provincial Office (#BR7515), Toronto, Ontario, Canada, and a personnel award to Dr Fowler from the Heart and Stroke Foundation, Ontario Provincial Office, Toronto, Ontario, Canada.
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
