Ebony T Lewis1,2,3, Reema Harrison4, Margaret Nicholson5,6, Ken Hillman5,6, Steven Trankle7, Shirley Rangel8, Claire Stokes9, Magnolia Cardona8,10. 1. School of Public Health and Community Medicine, The University of New South Wales, Level 3, Samuels Building, Gate 11, Botany Street, UNSW Sydney Campus, Sydney, NSW, 2052, Australia. ebony.lewis@unsw.edu.au. 2. School of Psychology, The University of New South Wales, Mathews Building Gate 11, Botany Street, UNSW Sydney Campus, Sydney, NSW, 2052, Australia. ebony.lewis@unsw.edu.au. 3. Neuroscience Research Australia, NeuRA, Margarete Ainsworth Building, Barker Street, Randwick, NSW, 2031, Australia. ebony.lewis@unsw.edu.au. 4. School of Public Health and Community Medicine, The University of New South Wales, Level 3, Samuels Building, Gate 11, Botany Street, UNSW Sydney Campus, Sydney, NSW, 2052, Australia. 5. South Western Sydney Clinical School, The University of New South Wales, Level 2, Education Building Liverpool Hospital, Cnr Elizabeth and Goulburn Streets, Liverpool, NSW, 2170, Australia. 6. Intensive Care Unit, Liverpool Hospital, Level 2, Clinical Building Liverpool Hospital, Cnr Elizabeth and Goulburn Streets, Liverpool, NSW, 2170, Australia. 7. Department of General Practice, Medical School, Western Sydney University, Building 30, Campbelltown Campus, Corner of Narellan Road and Gilchrist Drive, Campbelltown, NSW, 2560, Australia. 8. Gold Coast Hospital and Health Service, Professorial Unit Level 2, PED Building E, 1 Hospital Boulevard, Southport, QLD, 4215, Australia. 9. Griffith Health Clinics, Griffith University, Levels 3 and 4, Griffith Health Centre (G40), Gold Coast Campus, Cnr Parklands Drive and Olsen Ave, Southport, QLD, 4215, Australia. 10. Institute for Evidence-Based Healthcare, Bond University, Level 4, HSM 5, 14 University Drive, Gold Coast, QLD, 4229, Australia.
Abstract
BACKGROUND: Clinicians' delays to identify risk of death and communicate it to patients nearing the end of life contribute to health-related harm in health services worldwide. This study sought to ascertain doctors, nurses and senior members of the public's perceptions of the routine use of a screening tool to predict risk of death for older people. METHODS: Cross-sectional online, face-to-face and postal survey of 360 clinicians and 497 members of the public. RESULTS: Most (65.9%) of the members of the public welcomed (and 12.3% were indifferent to) the use of a screening tool as a decision guide to minimise overtreatment and errors from clinician assumptions. Supporters of the use of a prognostic tool were likely to be males with high social capital, chronically ill and who did not have an advance health directive. The majority of clinicians (75.6%) reported they were likely or very likely to use the tool, or might consider using it if convinced of its accuracy. A minority (13.3%) stated they preferred to rely on their clinical judgement and would be unlikely to use it. Differentials in support for tools by seniority were observed, with more support expressed by nurses, interns and registrars than medical specialists (χ2 = 12.95, p = 0.044) and by younger (< 40 years) clinicians (81.2% vs. 71.2%, p = 0.0058). DISCUSSION: The concept of integrating prognostication of death in routine practice was not resisted by either target group. CONCLUSION: Findings indicate that screening for risk of death is seen as potentially useful and suggests the readiness for a culture change. Future research on implementation strategies could be a step in the right direction.
BACKGROUND: Clinicians' delays to identify risk of death and communicate it to patients nearing the end of life contribute to health-related harm in health services worldwide. This study sought to ascertain doctors, nurses and senior members of the public's perceptions of the routine use of a screening tool to predict risk of death for older people. METHODS: Cross-sectional online, face-to-face and postal survey of 360 clinicians and 497 members of the public. RESULTS: Most (65.9%) of the members of the public welcomed (and 12.3% were indifferent to) the use of a screening tool as a decision guide to minimise overtreatment and errors from clinician assumptions. Supporters of the use of a prognostic tool were likely to be males with high social capital, chronically ill and who did not have an advance health directive. The majority of clinicians (75.6%) reported they were likely or very likely to use the tool, or might consider using it if convinced of its accuracy. A minority (13.3%) stated they preferred to rely on their clinical judgement and would be unlikely to use it. Differentials in support for tools by seniority were observed, with more support expressed by nurses, interns and registrars than medical specialists (χ2 = 12.95, p = 0.044) and by younger (< 40 years) clinicians (81.2% vs. 71.2%, p = 0.0058). DISCUSSION: The concept of integrating prognostication of death in routine practice was not resisted by either target group. CONCLUSION: Findings indicate that screening for risk of death is seen as potentially useful and suggests the readiness for a culture change. Future research on implementation strategies could be a step in the right direction.
Entities:
Keywords:
Death prediction; Frail older people; Prognostic uncertainty; Screening; Surveys