Improving serious illness communication: a qualitative study of clinical culture
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Le résumé fourni par la source
OBJECTIVE: Communication about patients' values, goals, and prognosis in serious illness (serious illness communication) is a cornerstone of person-centered care yet difficult to implement in practice. As part of Serious Illness Care Program implementation in five health systems, we studied the clinical culture-related factors that supported or impeded improvement in serious illness conversations. METHODS: Qualitative analysis of semi-structured interviews of clinical leaders, implementation teams, and frontline champions. RESULTS: We completed 30 interviews across palliative care, oncology, primary care, and hospital medicine. Participants identified four culture-related domains that influenced serious illness communication improvement: (1) clinical paradigms; (2) interprofessional empowerment; (3) perceived conversation impact; (4) practice norms. Changes in clinicians' beliefs, attitudes, and behaviors in these domains supported values and goals conversations, including: shifting paradigms about serious illness communication from 'end-of-life planning' to 'knowing and honoring what matters most to patients;' improvements in psychological safety that empowered advanced practice clinicians, nurses and social workers to take expanded roles; experiencing benefits of earlier values and goals conversations; shifting from avoidant norms to integration norms in which earlier serious illness discussions became part of routine processes. Culture-related inhibitors included: beliefs that conversations are about dying or withdrawing care; attitudes that serious illness communication is the physician's job; discomfort managing emotions; lack of reliable processes. CONCLUSIONS: Aspects of clinical culture, such as paradigms about serious illness communication and inter-professional empowerment, are linked to successful adoption of serious illness communication. Further research is warranted to identify effective strategies to enhance clinical culture and drive clinician practice change.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Improving serious illness communication: a qualitative study of clinical culture
- Date Crossref
- 22/07/2023
- Éditeur
- Springer Science and Business Media LLC
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Harvard University pays non établi dans la noticeUniversité ou école supérieure
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Massachusetts General Hospital pays non établi dans la noticeÉtablissement de santé
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Ariadne Labs pays non établi dans la noticeStructure de recherche
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McGill University pays non établi dans la noticeUniversité ou école supérieure
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Brigham and Women's Hospital pays non établi dans la noticeÉtablissement de santé
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Dana-Farber Cancer Institute pays non établi dans la noticeStructure de recherche
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Lund University pays non établi dans la noticeUniversité ou école supérieure
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UMass Memorial Health Care pays non établi dans la noticeÉtablissement de santé
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Joint Innovation Center at Brigham & Women's Hospital and Harvard T.H. Chan School of Public Health Ariadne Labs pays non établi dans la noticeUniversité ou école supérieure
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Harvard Medical School pays non établi dans la noticeInstitution
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Mongan Institute Center for Aging and Serious Illness pays non établi dans la noticeStructure de recherche
Harvard University, Massachusetts General Hospital et Ariadne Labs, avec 8 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.