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Obstacles to end-of-life discussions shared among clinicians

Clinicians cited family and patient-related factors as the biggest barriers in goals of care discussions, according to a survey published in JAMA Internal Medicine.

“Findings from our study suggest that certain patient and family member factors may deter clinicians from engaging in goals of care discussions,” John J. You, MD, MSc, of the departments of medicine and clinical epidemiology and biostatistics at McMaster University in Ontario, and colleagues wrote.

Researchers conducted a multicenter survey on the medical teaching units of 13 hospitals in Canada, and invited staff physicians, residents and nurses from participating centers, to assess the barriers involved with end-of-life care goal discussions.

Between September 2012 and March 2013, a total of 1,256 clinicians responded to the study questionnaire, including 512 nurses, 484 residents and 260 staff physicians, for an overall response rate of 77%.

Clinician groups unanimously identified four barriers as the most important barriers to goals of care discussions; patients’ or family members’ trouble accepting a poor prognosis, patients’ or family members’ difficulty understanding the limitations and problems of life-sustaining treatments, goals of care disputes among family members’ and patients’ inability to make goals of care decisions. Clinicians’ perceived their own skills and system factors as less important barriers.

“Promising interventions include more and better communication skills training for clinicians, conversation guides for discussion of prognosis, decision aids to support advance care planning and greater involvement of the interprofessional health care team in this important process of care,” You and colleagues wrote. – by Casey Hower

Disclosure: The researchers report receiving a grant from the Canadian Institutes for Health Research. The researchers report no relevant financial disclosures.