Role of allied health care professionals in goals-of-care discussions with hospitalized patients and perceived barriers: a cross-sectional survey.

Allied health care professionals can contribute meaningfully to goals-of-care discussions with seriously ill hospitalized patients and their families. We sought to explore the perspective of hospital-based allied health care professionals on their role in goals-of-care discussions and to identify barriers to their participation. We surveyed allied health care professionals (social workers, physiotherapists, occupational therapists, registered dietitians, speech-language pathologists and pharmacists) on internal medicine, hematology-oncology, medical oncology and radiation oncology wards at 2 tertiary care hospitals in Hamilton, Ontario, from April 2013 to May 2014. We modified a validated questionnaire originally designed to assess barriers to discussing goals of care from the perspective of nurses, residents and staff physicians on hospital medical wards. Respondents rated the questionnaire items on a 7-point Likert scale. Of the 47 allied health care professionals invited, 32 (68%) participated: 9 physiotherapists, 7 social workers, 6 occupational therapists, 4 registered dietitians, 3 pharmacists and 2 speech-language pathologists; in 1 case, the profession was unknown. The greatest perceived barriers to engaging in goals-of-care discussions were lack of patient decision-making capacity (mean rating 5.9 [standard error (SE) 0.3]), lack of awareness of patients' previous discussions with other team members (mean rating 5.7 [SE 0.3]) and family members' difficulty accepting a poor prognosis (mean rating 5.6 [SE 0.2]). Although the respondents felt it was most acceptable for staff physicians, residents and advanced practice nurses to exchange information and reach a final decision during goals-of-care discussions, they felt it was acceptable for a broader range of allied health care professionals to initiate discussions (mean rating 4.7-5.8) and to act as decision coaches (clarifying values, weighing options) with patients and families (mean rating 5.3-6.1). Allied health care professionals are willing to initiate goals-of-care discussions and to act as a decision coach with seriously ill hospitalized patients and their families. By improving interprofessional collaboration, we can engage the entire health care team in this process.

Martin L ，Patel A ，Piggott K ，Wong A ，Patel A ，Patel M ，Liu Y ，Dhesy-Thind S ，Wasi P ，You JJ ... -  《-》

Barriers to goals of care discussions with seriously ill hospitalized patients and their families: a multicenter survey of clinicians.

You JJ ，Downar J ，Fowler RA ，Lamontagne F ，Ma IW ，Jayaraman D ，Kryworuchko J ，Strachan PH ，Ilan R ，Nijjar AP ，Neary J ，Shik J ，Brazil K ，Patel A ，Wiebe K ，Albert M ，Palepu A ，Nouvet E ，des Ordons AR ，Sharma N ，Abdul-Razzak A ，Jiang X ，Day A ，Heyland DK ，Canadian Researchers at the End of Life Network ... -  《-》

Breaking silence: a survey of barriers to goals of care discussions from the perspective of oncology practitioners.

Piggott KL ，Patel A ，Wong A ，Martin L ，Patel A ，Patel M ，Liu Y ，Dhesy-Thind S ，You JJ ... -  《BMC CANCER》

Perceived barriers and facilitators to goals of care discussions in the emergency department: A descriptive analysis of the views of emergency medicine physicians and residents.

Argintaru N ，Quinn KL ，Chartier LB ，Lee J ，Hannam P ，O'Connor E ，Steinberg L ，Ovens H ，McGowan M ，Vaillancourt S ... -  《-》

A Multicenter Study to Identify Clinician Barriers to Participating in Goals of Care Discussions in Long-Term Care.

Long-term care (LTC) is an important setting for goals of care (GoC) discussions. Understanding clinician barriers to GoC discussions could identify opportunities for LTC-specific interventions to improve quantity and quality of GoC discussions in the context of serious illness. A multicenter, cross-sectional survey study. 1184 LTC clinicians from 34 Ontario LTC homes were invited to participate. The questionnaire assessed (1) clinician barriers related to the LTC resident power of attorney (POA), the health care provider, and the health care system; (2) willingness to engage in GoC discussions; and (3) suggestions to address identified barriers. Responses were rated on a 7-point scale (1 = extremely unimportant/unwilling, 7 = extremely important/willing). A linear mixed-effects model determined significance between mean importance ratings for each barrier and the willingness to engage in GoC discussion between physicians and nurses. A simple content analysis was performed on written suggestions to address GoC discussion barriers. The overall response rate was 49% (581/1184). The top 3 rated barriers were (1) POA's difficulty accepting their loved one's poor prognosis, (2) POA's difficulty understanding the limitations and complications of life-sustaining therapies, and (3) lack of adequate documentation of prior discussions with LTC resident or POA. Barriers related to the health care provider, and the health care system, were deemed statistically more important by nurses. LTC physicians were more willing to exchange information, be a decision coach, and participate in the final decision than nurses. Suggestions to improve GoC discussions include a dedicated team to have these conversations in LTC, and updating policies to mandate and standardize these conversations at all family meetings. This study has identified key LTC clinician-identified barriers to GoC discussions. Developing targeted interventions to these barriers could be the foundation for developing new interventions that support high-quality GoC discussions.

Siu HYH ，Elston D ，Arora N ，Vahrmeyer A ，Kaasalainen S ，Chidwick P ，Howard M ，Heyland DK ... -  《-》