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A qualitative study exploring challenges and solutions to negotiating goals of care at the end of life in hospital settings

Abstract
Background

Negotiating goals of care with patients is an essential skill for all health care professionals in hospitals. End-of-Life Essentials (EOLE) is a Commonwealth funded project that delivers free, peer-reviewed, evidence-based, online education and practice change resources. To date, around 26 000 doctors, nurses and allied health professionals have registered to access the education. ‘Planning End-of-Life Care – Goals of Care’ features in the suite of EOLE modules and includes education around negotiating goals of care with patients and families. The aim of the study was to explore the views of module learners (health care professionals) on challenges they have faced when negotiating goals of care at the end of life with patients and families.

Methods

Participants were learners (health care professionals) who registered to the EOLE website and engaged with the Goals of Care module. Learner responses to the question posed at the end of the module ‘‘What are the hardest or most challenging things about negotiating goals of care with patients and families?’ were extracted for a 12 month period. Qualitative data were analysed thematically in NVivo V.12, guided by the theoretical framework of pragmatism. An open, inductive approach was used to code the data, with axial coding used to refine and organise themes and subthemes.

Results

A total of 451 learner statements were analysed. Five themes emerged from the data: 1) differing views and opinions, 2) challenges to understanding, 3) managing emotions, 4) initiating the end-of-life conversation, and 5) lack of professional knowledge or capacity. Five subthemes were also organised under the theme differing views and opinions.

Conclusion

Planning end-of-life care demands high level, compassionately skilful, and sensitive care and services, which are in line with the patient and family wishes. In practice however, there are many challenges to this, such as ensuring that patients, families, and health care professionals are aware of different expectations regarding future health care possibilities, and that health care professionals are prepared for negotiating goals of care to achieve quality and safe end-of-life care in hospitals.

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Posted in: Journal Article Abstracts on 11/07/2022 | Link to this post on IFP |
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