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- Title
The differences in code status conversation approaches reported by emergency medicine and palliative care clinicians: A mixed‐method study.
- Authors
Ouchi, Kei; Prachanukool, Thidathit; Aaronson, Emily L.; Lakin, Joshua R.; Higuchi, Masaya; Liu, Shan W.; Kennedy, Maura; Revette, Anna C.; Chary, Anita N.; Kaithamattam, Jenson; Lee, Brandon; Neville, Thanh H.; Hasdianda, Mohammad A.; Sudore, Rebecca; Schonberg, Mara A.; Tulsky, James A.; Block, Susan D.
- Abstract
Background: During acute health deterioration, emergency medicine and palliative care clinicians routinely discuss code status (e.g., shared decision making about mechanical ventilation) with seriously ill patients. Little is known about their approaches. We sought to elucidate how code status conversations are conducted by emergency medicine and palliative care clinicians and why their approaches are different. Methods: We conducted a sequential‐explanatory, mixed‐method study in three large academic medical centers in the Northeastern United States. Attending physicians and advanced practice providers working in emergency medicine and palliative care were eligible. Among the survey respondents, we purposefully sampled the participants for follow‐up interviews. We collected clinicians' self‐reported approaches in code status conversations and their rationales. A survey with a 5‐point Likert scale ("very unlikely" to "very likely") was used to assess the likelihood of asking about medical procedures (procedure based) and patients' values (value based) during code status conversations, followed by semistructured interviews. Results: Among 272 clinicians approached, 206 completed the survey (a 76% response rate). The reported approaches differed greatly (e.g., 91% of palliative care clinicians reported asking about a patient's acceptable quality of life compared to 59% of emergency medicine clinicians). Of the 206 respondents, 118 (57%) agreed to subsequent interviews; our final number of semistructured interviews included seven emergency medicine clinicians and nine palliative care clinicians. The palliative care clinicians stated that the value‐based questions offer insight into patients' goals, which is necessary for formulating a recommendation. In contrast, emergency medicine clinicians stated that while value‐based questions are useful, they are vague and necessitate extended discussions, which are inappropriate during emergencies. Conclusions: Emergency medicine and palliative care clinicians reported conducting code status conversations differently. The rationales may be shaped by their clinical practices and experiences.
- Subjects
NEW England; ACADEMIC medical centers; TERMINALLY ill; CONVERSATION; ATTITUDES of medical personnel; RESEARCH methodology; SELF-evaluation; INTERVIEWING; ARTIFICIAL respiration; DECISION making; QUALITY of life; RESEARCH funding; PATIENT-professional relations; JUDGMENT sampling; EMERGENCY medicine; PALLIATIVE treatment
- Publication
Academic Emergency Medicine, 2024, Vol 31, Issue 1, p18
- ISSN
1069-6563
- Publication type
Article
- DOI
10.1111/acem.14818