Amy Durall1, David Zurakowski, Joanne Wolfe. 1. Department of Anesthesiology, Perioperative and Pain Medicine, Children’s Hospital Boston, Boston, Massachusetts 02115, USA. amy.durall@childrens.harvard.edu
Abstract
BACKGROUND AND OBJECTIVE: Advance care discussions (ACD) occur infrequently or are initiated late in the course of illness. Although data exist regarding barriers to ACD among the care of adult patients, few pediatric data exist. The goal of this study was to identify barriers to conducting ACD for children with life-threatening conditions. METHODS: Physicians and nurses from practice settings where advance care planning typically takes place were surveyed to collect data regarding their attitudes and behaviors regarding ACD. RESULTS: A total of 266 providers responded to the survey: 107 physicians and 159 nurses (54% response rate). The top 3 barriers were: unrealistic parent expectations, differences between clinician and patient/parent understanding of prognosis, and lack of parent readiness to have the discussion. Nurses identified lack of importance to clinicians (P = .006) and ethical considerations (P < .001) as impediments more often than physicians. Conversely, physicians believed that not knowing the right thing to say (P = .006) was more often a barrier. There are also perceived differences among specialties. Cardiac ICU providers were more likely to report unrealistic clinician expectations (P < .001) and differences between clinician and patient/parent understanding of prognosis (P = .014) as common barriers to conducting ACD. Finally, 71% of all clinicians believed that ACD happen too late in the patient's clinical course. CONCLUSIONS: Clinicians perceive parent prognostic understanding and attitudes as the most common barriers to conducting ACD. Educational interventions aimed at improving clinician knowledge, attitudes, and skills in addressing these barriers may help health care providers overcome perceived barriers.
BACKGROUND AND OBJECTIVE: Advance care discussions (ACD) occur infrequently or are initiated late in the course of illness. Although data exist regarding barriers to ACD among the care of adult patients, few pediatric data exist. The goal of this study was to identify barriers to conducting ACD for children with life-threatening conditions. METHODS: Physicians and nurses from practice settings where advance care planning typically takes place were surveyed to collect data regarding their attitudes and behaviors regarding ACD. RESULTS: A total of 266 providers responded to the survey: 107 physicians and 159 nurses (54% response rate). The top 3 barriers were: unrealistic parent expectations, differences between clinician and patient/parent understanding of prognosis, and lack of parent readiness to have the discussion. Nurses identified lack of importance to clinicians (P = .006) and ethical considerations (P < .001) as impediments more often than physicians. Conversely, physicians believed that not knowing the right thing to say (P = .006) was more often a barrier. There are also perceived differences among specialties. Cardiac ICU providers were more likely to report unrealistic clinician expectations (P < .001) and differences between clinician and patient/parent understanding of prognosis (P = .014) as common barriers to conducting ACD. Finally, 71% of all clinicians believed that ACD happen too late in the patient's clinical course. CONCLUSIONS: Clinicians perceive parent prognostic understanding and attitudes as the most common barriers to conducting ACD. Educational interventions aimed at improving clinician knowledge, attitudes, and skills in addressing these barriers may help health care providers overcome perceived barriers.
Authors: Nneka N Ufere; John Donlan; Lauren Waldman; Arpan Patel; Jules L Dienstag; Lawrence S Friedman; Kathleen E Corey; Nikroo Hashemi; Peter Carolan; Alan C Mullen; Michael Thiim; Irun Bhan; Ryan Nipp; Joseph Greer; Jennifer Temel; Raymond T Chung; Areej El-Jawahri Journal: Liver Transpl Date: 2019-05-03 Impact factor: 5.799
Authors: Douglas L Hill; Jennifer K Walter; Jessica A Casas; Concetta DiDomenico; Julia E Szymczak; Chris Feudtner Journal: Support Care Cancer Date: 2018-04-07 Impact factor: 3.603
Authors: Douglas L Hill; Jennifer K Walter; Julia E Szymczak; Concetta DiDomenico; Shefali Parikh; Chris Feudtner Journal: J Pain Symptom Manage Date: 2019-08-16 Impact factor: 3.612
Authors: Nneka N Ufere; John Donlan; Lauren Waldman; Jules L Dienstag; Lawrence S Friedman; Kathleen E Corey; Nikroo Hashemi; Peter Carolan; Alan C Mullen; Michael Thiim; Irun Bhan; Ryan Nipp; Joseph A Greer; Jennifer S Temel; Raymond T Chung; Areej El-Jawahri Journal: Clin Gastroenterol Hepatol Date: 2019-03-15 Impact factor: 11.382
Authors: Ronald H Dallas; Allison Kimmel; Megan L Wilkins; Sohail Rana; Ana Garcia; Yao I Cheng; Jichuan Wang; Maureen E Lyon Journal: Pediatrics Date: 2016-11-01 Impact factor: 7.124
Authors: Christopher J Lin; Yao I Cheng; Patricia A Garvie; Lawrence J D'Angelo; Jichuan Wang; Maureen E Lyon Journal: J Fam Nurs Date: 2020-11 Impact factor: 3.818