Exploring expanded interdisciplinary roles in goals of care conversations in a national goals of care initiative: A qualitative approach
Autor: | Marie C. Haverfield, Jill Lowery, Jessica Ma, Karleen F. Giannitrapani, Cati Brown-Johnson, Natalie Lo, Mary Beth Foglia, David B. Bekelman, Anne Walling, Karl A. Lorenz |
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Rok vydání: | 2021 |
Předmět: |
business.industry
Communication General Medicine Veterans health Hospitals Patient Care Planning 03 medical and health sciences 0302 clinical medicine Anesthesiology and Pain Medicine Nursing 030220 oncology & carcinogenesis Health care Medicine Humans Center (algebra and category theory) 030212 general & internal medicine Treatment decision making business Administration (government) Delivery of Health Care Qualitative Research Qualitative research Veterans |
Zdroj: | Palliative medicine. 35(8) |
ISSN: | 1477-030X |
Popis: | Background: The United States Veterans Health Administration National Center for Ethics in Health Care implemented the Life-Sustaining Treatment Decisions Initiative throughout the Veterans Health Administration health care system in 2017. This policy encourages goals of care conversations, referring to conversations about patient’s treatment and end-of-life wishes for life-sustaining treatments, among Veterans with serious illnesses. A key component of the initiative is expanding interdisciplinary provider roles in having goals of care conversations. Aim: Use organizational role theory to explore medical center experiences with expanding interdisciplinary roles in the implementation of a goals of care initiative. Design: A qualitative thematic analysis of semi-structured interviews. Setting/participants: Initial participants were recruited using purposive sampling of local medical center champions. Snowball sampling identified additional participants. Participants included thirty-one interdisciplinary providers from 12 geographically diverse initiative pilot and spread medical centers. Results: Five themes were identified. Expanding provider roles in goals of care conversations (1) involves organizational culture change; (2) is influenced by medical center leadership; (3) is supported by provider role readiness; (4) benefits from cross-disciplinary role agreement; and (5) can “overwhelm” providers. Conclusions: Organizational role theory is a helpful framework for exploring interdisciplinary roles in a goals of care initiative. Support and recognition of provider role expansion in goals of care conversations was important for the adoption of a goals of care initiative. Actionable strategies, including multi-level leadership support and the use of interdisciplinary champions, facilitate role change and have potential to strengthen uptake of a goals of care initiative. |
Databáze: | OpenAIRE |
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