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An exploration of contextual dimensions impacting goals of care conversations in postgraduate medical education

Roze des Ordons, Amanda L., Lockyer, Jocelyn, Hartwick, Michael, Sarti, Aimee and Ajjawi, Rola 2016, An exploration of contextual dimensions impacting goals of care conversations in postgraduate medical education, BMC palliative care, vol. 15, Article number: 34, pp. 1-9, doi: 10.1186/s12904-016-0107-6.

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Title An exploration of contextual dimensions impacting goals of care conversations in postgraduate medical education
Author(s) Roze des Ordons, Amanda L.
Lockyer, Jocelyn
Hartwick, Michael
Sarti, Aimee
Ajjawi, Rola
Journal name BMC palliative care
Volume number 15
Season Article number: 34
Start page 1
End page 9
Total pages 9
Publisher BioMed Central
Place of publication London, Eng.
Publication date 2016-03-21
ISSN 1472-684X
1472-684X
Keyword(s) Communication
Context
Goals of care
Postgraduate medical education
Qualitative
Canada
Education, Medical, Graduate
Focus Groups
Health Personnel
Humans
Internal Medicine
Qualitative Research
Social Skills
Staff Development
Science & Technology
Life Sciences & Biomedicine
Health Care Sciences & Services
Health Policy & Services
OF-LIFE CARE
SERIOUS ILLNESS
HOSPITALIZED-PATIENTS
RESIDENT PHYSICIANS
DISCUSSING GOALS
HEALTH-CARE
END
PATIENT
EXPERIENCE
Summary BACKGROUND: Postgraduate medical trainees are not well prepared difficult conversations about goals of care with patients and families in the acute care clinical setting. While contextual nuances within the workplace can impact communication, research to date has largely focused on individual communication skills. Our objective was to explore contextual factors that influence conversations between trainees and patients/families about goals of care in the acute care setting.

METHODS: We conducted an exploratory qualitative study involving five focus groups with Internal Medicine trainees (n = 20) and a series of interviews with clinical faculty (n = 11) within a single Canadian centre. Thematic framework analysis was applied to categorize the data and identify themes and subthemes.

RESULTS: Challenges and factors enabling goals of care conversations emerged within individual, interpersonal and system dimensions. Challenges included inadequate preparation for these conversations, disconnection between trainees, faculty and patients, policies around documentation, the structure of postgraduate medical education, and resource limitations; these challenges led to missed opportunities, uncertainty and emotional distress. Enabling factors were awareness of the importance of goals of care conversations, support in these discussions, collaboration with colleagues, and educational initiatives enabling skill development; these factors have resulted in learning, appreciation, and an established foundation for future educational initiatives.

CONCLUSIONS: Contextual factors impact how postgraduate medical trainees communicate with patients/families about goals of care. Attention to individual, interpersonal and system-related factors will be important in designing educational programs that help trainees develop the capacities needed for challenging conversations.
Language eng
DOI 10.1186/s12904-016-0107-6
Field of Research 130209 Medicine, Nursing and Health Curriculum and Pedagogy
130202 Curriculum and Pedagogy Theory and Development
1117 Public Health And Health Services
Socio Economic Objective 930201 Pedagogy
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2016, Roze des Ordons et al.
Free to Read? Yes
Use Rights Creative Commons Attribution licence
Persistent URL http://hdl.handle.net/10536/DRO/DU:30082733

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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.