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Cultures of Practice: Specialty-Specific Differences in End-of-Life Conversations
Importance: Goals of care discussions at the end of life give opportunity to affirm the autonomy and humanity of dying patients. Best practices exist for communication around goals of care, but there is no research on differences in approach taken by different specialties engaging these conversation...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Mary Ann Liebert, Inc., publishers
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8043084/ https://www.ncbi.nlm.nih.gov/pubmed/33860283 http://dx.doi.org/10.1089/pmr.2020.0054 |
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author | Morales, Andre Schultz, Kevan C. Gao, Shasha Murphy, Alan Barnato, Amber E. Fanning, Joseph B. Hall, Daniel E. |
author_facet | Morales, Andre Schultz, Kevan C. Gao, Shasha Murphy, Alan Barnato, Amber E. Fanning, Joseph B. Hall, Daniel E. |
author_sort | Morales, Andre |
collection | PubMed |
description | Importance: Goals of care discussions at the end of life give opportunity to affirm the autonomy and humanity of dying patients. Best practices exist for communication around goals of care, but there is no research on differences in approach taken by different specialties engaging these conversations. Objective: To describe the communication practices of internal medicine (IM), emergency medicine (EM), and critical care (CC) physicians in a high-fidelity simulation of a terminally ill patient with stable and defined end-of-life preferences. Design, Setting, and Participants: Mixed-methods secondary analysis of transcripts obtained from a multicenter study simulating high stakes, time-limited end-of-life decision making in a cohort of 88 volunteer physicians (27 IM, 22 EM, and 39 CC) who were called to evaluate a standardized patient in extremis. The patient had clear comfort-oriented goals of care that the physician needed to elicit and use to inform treatment decisions. Discussions were coded at the level of the sentence for semantic content. Exposures: Data were analyzed by physician specialty. Main Outcome Measure: Occurrence of content codes indicative of prudent (right outcome by the right means) goals of care conversations. Data were analyzed both for number of occurrences of the code in a simulated conversation and for presence or absence of the code within a conversation. Results: There was no difference between physician types in intubation rates or intensive care unit admissions. Codes for “comfort as a goal of care,” “noncurative goals of care,” and “oblique references to death” emerged as significantly different between physician types. Conclusions and Relevance: This experiment shows demonstrable differences in practice patterns between physician specialties when addressing end-of-life decision making. Some of the variation likely arose from differences in setting, but these data suggest that training in goals of care conversations may benefit if it is adapted to the distinct needs and culture of each specialty. |
format | Online Article Text |
id | pubmed-8043084 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Mary Ann Liebert, Inc., publishers |
record_format | MEDLINE/PubMed |
spelling | pubmed-80430842021-04-13 Cultures of Practice: Specialty-Specific Differences in End-of-Life Conversations Morales, Andre Schultz, Kevan C. Gao, Shasha Murphy, Alan Barnato, Amber E. Fanning, Joseph B. Hall, Daniel E. Palliat Med Rep Original Article Importance: Goals of care discussions at the end of life give opportunity to affirm the autonomy and humanity of dying patients. Best practices exist for communication around goals of care, but there is no research on differences in approach taken by different specialties engaging these conversations. Objective: To describe the communication practices of internal medicine (IM), emergency medicine (EM), and critical care (CC) physicians in a high-fidelity simulation of a terminally ill patient with stable and defined end-of-life preferences. Design, Setting, and Participants: Mixed-methods secondary analysis of transcripts obtained from a multicenter study simulating high stakes, time-limited end-of-life decision making in a cohort of 88 volunteer physicians (27 IM, 22 EM, and 39 CC) who were called to evaluate a standardized patient in extremis. The patient had clear comfort-oriented goals of care that the physician needed to elicit and use to inform treatment decisions. Discussions were coded at the level of the sentence for semantic content. Exposures: Data were analyzed by physician specialty. Main Outcome Measure: Occurrence of content codes indicative of prudent (right outcome by the right means) goals of care conversations. Data were analyzed both for number of occurrences of the code in a simulated conversation and for presence or absence of the code within a conversation. Results: There was no difference between physician types in intubation rates or intensive care unit admissions. Codes for “comfort as a goal of care,” “noncurative goals of care,” and “oblique references to death” emerged as significantly different between physician types. Conclusions and Relevance: This experiment shows demonstrable differences in practice patterns between physician specialties when addressing end-of-life decision making. Some of the variation likely arose from differences in setting, but these data suggest that training in goals of care conversations may benefit if it is adapted to the distinct needs and culture of each specialty. Mary Ann Liebert, Inc., publishers 2021-03-24 /pmc/articles/PMC8043084/ /pubmed/33860283 http://dx.doi.org/10.1089/pmr.2020.0054 Text en © Andre Morales et al., 2021; Published by Mary Ann Liebert, Inc. https://creativecommons.org/licenses/by/4.0/This Open Access article is distributed under the terms of the Creative Commons License [CC-BY] (http://creativecommons.org/licenses/by/4.0 (https://creativecommons.org/licenses/by/4.0/) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Article Morales, Andre Schultz, Kevan C. Gao, Shasha Murphy, Alan Barnato, Amber E. Fanning, Joseph B. Hall, Daniel E. Cultures of Practice: Specialty-Specific Differences in End-of-Life Conversations |
title | Cultures of Practice: Specialty-Specific Differences in End-of-Life Conversations |
title_full | Cultures of Practice: Specialty-Specific Differences in End-of-Life Conversations |
title_fullStr | Cultures of Practice: Specialty-Specific Differences in End-of-Life Conversations |
title_full_unstemmed | Cultures of Practice: Specialty-Specific Differences in End-of-Life Conversations |
title_short | Cultures of Practice: Specialty-Specific Differences in End-of-Life Conversations |
title_sort | cultures of practice: specialty-specific differences in end-of-life conversations |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8043084/ https://www.ncbi.nlm.nih.gov/pubmed/33860283 http://dx.doi.org/10.1089/pmr.2020.0054 |
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