The differences in code status conversation approaches reported by emergency medicine and palliative care clinicians: A mixed-method study.

Autor: Ouchi K; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA.; Serious Illness Care Program, Ariadne Labs, Boston, Massachusetts, USA.; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA., Prachanukool T; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA.; Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand., Aaronson EL; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA.; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA., Lakin JR; Serious Illness Care Program, Ariadne Labs, Boston, Massachusetts, USA.; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.; Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA., Higuchi M; Division of Palliative Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA., Liu SW; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA.; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA., Kennedy M; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA.; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA., Revette AC; Survey and Data Management Core, Dana-Farber Cancer Institute, Boston, Massachusetts, USA., Chary AN; Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA., Kaithamattam J; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA., Lee B; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA., Neville TH; Division of Pulmonary and Critical Care, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA., Hasdianda MA; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA., Sudore R; Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA., Schonberg MA; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA., Tulsky JA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.; Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA., Block SD; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.; Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Jazyk: angličtina
Zdroj: Academic emergency medicine : official journal of the Society for Academic Emergency Medicine [Acad Emerg Med] 2024 Jan; Vol. 31 (1), pp. 18-27. Date of Electronic Publication: 2023 Oct 29.
DOI: 10.1111/acem.14818
Abstrakt: Background: During acute health deterioration, emergency medicine and palliative care clinicians routinely discuss code status (e.g., shared decision making about mechanical ventilation) with seriously ill patients. Little is known about their approaches. We sought to elucidate how code status conversations are conducted by emergency medicine and palliative care clinicians and why their approaches are different.
Methods: We conducted a sequential-explanatory, mixed-method study in three large academic medical centers in the Northeastern United States. Attending physicians and advanced practice providers working in emergency medicine and palliative care were eligible. Among the survey respondents, we purposefully sampled the participants for follow-up interviews. We collected clinicians' self-reported approaches in code status conversations and their rationales. A survey with a 5-point Likert scale ("very unlikely" to "very likely") was used to assess the likelihood of asking about medical procedures (procedure based) and patients' values (value based) during code status conversations, followed by semistructured interviews.
Results: Among 272 clinicians approached, 206 completed the survey (a 76% response rate). The reported approaches differed greatly (e.g., 91% of palliative care clinicians reported asking about a patient's acceptable quality of life compared to 59% of emergency medicine clinicians). Of the 206 respondents, 118 (57%) agreed to subsequent interviews; our final number of semistructured interviews included seven emergency medicine clinicians and nine palliative care clinicians. The palliative care clinicians stated that the value-based questions offer insight into patients' goals, which is necessary for formulating a recommendation. In contrast, emergency medicine clinicians stated that while value-based questions are useful, they are vague and necessitate extended discussions, which are inappropriate during emergencies.
Conclusions: Emergency medicine and palliative care clinicians reported conducting code status conversations differently. The rationales may be shaped by their clinical practices and experiences.
(© 2023 Society for Academic Emergency Medicine.)
Databáze: MEDLINE
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