John J You1, Natasha Aleksova2, Anique Ducharme3, Jane MacIver4, Lisa Mielniczuk5, Robert A Fowler6, Catherine Demers7, Brian Clarke8, Marie-Claude Parent9, Mustafa Toma10, Patricia H Strachan11, Paul Farand12, Debra Isaac13, Shelley Zieroth14, Marilyn Swinton15, Xuran Jiang16, Andrew G Day16, Daren K Heyland17, Heather J Ross18. 1. Departments of Medicine, and Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada. Electronic address: jyou@mcmaster.ca. 2. Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. 3. Montreal Heart Institute, Montreal, Quebec, Canada. 4. Peter Munk Cardiac Center, University Health Network; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada. 5. University of Ottawa Heart Institute, Ottawa, Ontario, Canada. 6. Department of Medicine and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada. 7. Department of Medicine, McMaster University, Hamilton, Ontario, Canada. 8. Department of Medicine, Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada; QE II Health Science Centre, Halifax, Nova Scotia, Canada. 9. Hôpital du Sacré-Cœur de Montréal, Université de Montréal, Montreal, Quebec, Canada. 10. Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. 11. School of Nursing, McMaster University, Hamilton, Ontario, Canada. 12. Department of Medicine, Sherbrooke University, Sherbrooke, Quebec, Canada. 13. Department of Medicine, University of Calgary, Calgary, Alberta, Canada. 14. St. Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada. 15. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada. 16. Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada. 17. Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada. 18. Peter Munk Cardiac Center, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Abstract
BACKGROUND: Conversations about goals of care in hospital are important to patients who have advanced heart failure (HF). METHODS: We conducted a multicenter survey of cardiology nurses, fellows, and cardiologists at 8 Canadian teaching hospitals. The primary outcome was the importance of barriers to goals-of-care discussions in hospital (1 = extremely unimportant; 7 = extremely important). We also elicited perspectives on roles of different practitioners in having these conversations. RESULTS: Questionnaires were returned by 770/1024 (75.2%) eligible clinicians. The most important perceived barriers were: family members' and patients' difficulty in accepting a poor prognosis (mean [SD] score 5.9 [1.1] and 5.7 [1.2], respectively), family members' and patients' lack of understanding about the limitations and harms of life-sustaining treatments (5.8 [1.1] and 5.7 [1.2], respectively), and lack of agreement among family members about goals of care (5.8 [1.2]). Interprofessional team members were viewed as having different but important roles in goals-of-care discussions. CONCLUSIONS: Cardiology clinicians perceive family and patient-related factors as the most important barriers to goals-of-care discussions in hospital. Many members of the interprofessional team were viewed as having important roles in addressing goals of care. These findings can inform the design of future interventions to improve communication about goals of care in advanced HF.
BACKGROUND: Conversations about goals of care in hospital are important to patients who have advanced heart failure (HF). METHODS: We conducted a multicenter survey of cardiology nurses, fellows, and cardiologists at 8 Canadian teaching hospitals. The primary outcome was the importance of barriers to goals-of-care discussions in hospital (1 = extremely unimportant; 7 = extremely important). We also elicited perspectives on roles of different practitioners in having these conversations. RESULTS: Questionnaires were returned by 770/1024 (75.2%) eligible clinicians. The most important perceived barriers were: family members' and patients' difficulty in accepting a poor prognosis (mean [SD] score 5.9 [1.1] and 5.7 [1.2], respectively), family members' and patients' lack of understanding about the limitations and harms of life-sustaining treatments (5.8 [1.1] and 5.7 [1.2], respectively), and lack of agreement among family members about goals of care (5.8 [1.2]). Interprofessional team members were viewed as having different but important roles in goals-of-care discussions. CONCLUSIONS: Cardiology clinicians perceive family and patient-related factors as the most important barriers to goals-of-care discussions in hospital. Many members of the interprofessional team were viewed as having important roles in addressing goals of care. These findings can inform the design of future interventions to improve communication about goals of care in advanced HF.
Authors: Michael K Y Wong; Maria Cassandre Medor; Katerina Yelle Labre; Mengzhu Jiang; Jason R Frank; Lisa M Fischer; Warren J Cheung Journal: CMAJ Open Date: 2019-09-16
Authors: Florence Landry-Hould; Blandine Mondésert; Andrew G Day; Heather J Ross; Judith Brouillette; Brian Clarke; Shelley Zieroth; Mustafa Toma; Marie-Claude Parent; Robert A Fowler; John J You; Anique Ducharme Journal: CJC Open Date: 2021-08-08
Authors: Johnny T K Cheung; Doreen Au; Anthony H F Ip; Jenny Chan; Kenway Ng; Lok Cheung; Jacqueline Yuen; Elsie Hui; Jenny Lee; Raymond Lo; Jean Woo Journal: BMC Palliat Care Date: 2020-06-08 Impact factor: 3.234