Leah B Rosenberg1, Jeff Greenwald2, Bartho Caponi3, Ami Doshi4, Howard Epstein5, Jeff Frank6, Elizabeth Lindenberger7, Nick Marzano8, Lynnea M Mills9, Rab Razzak10, James Risser11, Wendy G Anderson9,12,13. 1. 1 Division of Palliative Care, Massachusetts General Hospital , Boston, Massachusetts. 2. 2 Core Educator Faculty, Department of Medicine, Massachusetts General Hospital , Boston, Massachusetts. 3. 3 Division of Hospital Medicine, University of Wisconsin , School of Medicine and Public Health, Madison, Wisconsin. 4. 4 Division of Pediatric Hospital Medicine, Rady Children's Hospital and University of California , San Diego, California. 5. 5 Board of Directors, Society of Hospital Medicine , Philadelphia, Pennsylvania. 6. 6 CEP America , Emeryville, California. 7. 7 Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai , New York, New York. 8. 8 Society of Hospital Medicine , Philadelphia, Pennsylvania. 9. 9 Division of Hospital Medicine, University of California , San Francisco, California. 10. 10 Palliative Medicine Program, Division of General Internal Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland. 11. 11 Department of Hospital Medicine, Regions Hospital , St Paul, Minnesota. 12. 12 Palliative Care Program, University of California , San Francisco, California. 13. 13 Department of Physiological Nursing, University of California San Francisco School of Nursing , San Francisco, California.
Abstract
OBJECTIVE: To describe the concerns, confidence, and barriers of practicing hospitalists around serious illness communication. BACKGROUND: Hospitalist physicians are optimally positioned to provide primary palliative care, yet their experiences in serious illness communication are not well described. METHODS: Web-based survey, conducted in May 2016. The survey link was distributed via email to 4000 members of the Society of Hospital Medicine. The 39-item survey assessed frequency of concerns about serious illness communication, confidence for common tasks, and barriers using Likert-type scales. It was developed by the authors based on prior work, a focus group, and feedback from pilot respondents. RESULTS: We received 332 completed surveys. On most or every shift, many participants reported having concerns about a patient's or family's understanding of prognosis (53%) or the patient's code status (63%). Most participants were either confident or very confident in discussing goals of care (93%) and prognosis (87%). Fewer were confident or very confident in responding to patients or families who had not accepted the seriousness of an illness (59%) or in managing conflict (50%). Other frequently cited barriers were lack of time, lack of prior discussions in the outpatient setting, unrealistic prognostic expectations from other physicians, limited institutional support, and difficulty finding records of previous discussions. DISCUSSION: Our results suggest opportunities to improve hospitalists' ability to lead serious illness communication by increasing the time hospitalists have for discussions, improving documentation systems and communication between inpatient and outpatient clinicians, and targeted training on challenging communication scenarios.
OBJECTIVE: To describe the concerns, confidence, and barriers of practicing hospitalists around serious illness communication. BACKGROUND: Hospitalist physicians are optimally positioned to provide primary palliative care, yet their experiences in serious illness communication are not well described. METHODS: Web-based survey, conducted in May 2016. The survey link was distributed via email to 4000 members of the Society of Hospital Medicine. The 39-item survey assessed frequency of concerns about serious illness communication, confidence for common tasks, and barriers using Likert-type scales. It was developed by the authors based on prior work, a focus group, and feedback from pilot respondents. RESULTS: We received 332 completed surveys. On most or every shift, many participants reported having concerns about a patient's or family's understanding of prognosis (53%) or the patient's code status (63%). Most participants were either confident or very confident in discussing goals of care (93%) and prognosis (87%). Fewer were confident or very confident in responding to patients or families who had not accepted the seriousness of an illness (59%) or in managing conflict (50%). Other frequently cited barriers were lack of time, lack of prior discussions in the outpatient setting, unrealistic prognostic expectations from other physicians, limited institutional support, and difficulty finding records of previous discussions. DISCUSSION: Our results suggest opportunities to improve hospitalists' ability to lead serious illness communication by increasing the time hospitalists have for discussions, improving documentation systems and communication between inpatient and outpatient clinicians, and targeted training on challenging communication scenarios.
Entities:
Keywords:
hospitalists; serious illness communication; survey research
Authors: Anuj K Dalal; Patricia Dykes; Lipika Samal; Kelly McNally; Eli Mlaver; Cathy S Yoon; Stuart R Lipsitz; David W Bates Journal: Appl Clin Inform Date: 2019-05-29 Impact factor: 2.342