No Easy Talk: A Mixed Methods Study of Doctor Reported Barriers to Conducting Effective End-of-Life Conversations with Diverse Patients.
No Easy Talk: A Mixed Methods Study of Doctor Reported Barriers to Conducting Effective End-of-Life Conversations with Diverse Patients.
复制标题
DOI：
10.1371/journal.pone.0122321
复制
发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Kraemer H
中科院分区：
文献类型：
--
作者：
Periyakoil VS;Neri E;Kraemer H
虽然大多数患者希望讨论临终（EOL）问题，但医生不愿意进行临终对话。医生在与不同患者进行有效的EOL对话时面临的障碍知之甚少。进行该混合方法研究以经验性地确定医生在与不同患者进行有效的EOL对话时所面临的障碍（如果有的话），并确定医生的年龄、性别、种族和医学亚专业是否影响所报告的障碍。在培训结束时，对两个大型学术医疗中心的多专科医生照顾不同的重病患者进行混合方法研究;数据收集自2010年至2012年。医生报告的与不同患者进行EOL对话的障碍。1234例潜在受试者中有1040例（84.3%）参与了研究。29名参与者被指定为编码和扎根理论分析的发展队列，以确定主要障碍。通过分析验证队列（n= 996名医生）中随机抽取的50名受试者的回复，对代码进行了验证。使用定量方法对验证队列的定性响应进行编码和分析。只有0.01%的医生报告与患者进行EOL对话没有障碍。99.99%的医生报告了障碍，85.7%的医生认为与所有患者进行EOL对话非常具有挑战性，尤其是与种族不同的患者进行对话。亚裔美国医生报告说，在与患者进行EOL对话时，最困难（91.3%），其次是非洲裔美国人（85.3%），白人（83.5%）和西班牙裔美国人（79.3%）。医生报告的有效EOL对话的最大障碍是（i）语言和医学解释问题，（ii）患者/家庭关于死亡和临终的宗教精神信仰，（iii）医生对患者文化信仰，价值观和实践的无知，（iv）患者/家庭在真相处理和决策方面的文化差异，（v）病人的健康知识有限;及（vi）病人不信任医生及医护制度。医生的种族（卡方= 12.77，DF = 4，p = 0.0125）和医学亚专业（卡方= 19.33，DF = 10，p =0.036）影响他们报告的障碍。用于检查参与者跨亚组障碍的相对排名的Friedman检验确定了年龄组（F统计值= 303.5，DF = 5，p < 0.0001）和医学亚专业（F统计值=163.7，DF = 5，p < 0.0001）的显著差异。医生报告说，他们很难与所有患者进行有效的EOL对话，特别是与那些种族与自己不同的患者进行对话。重要的是要确定策略，以减轻医生在与重病患者及其家属进行有效的EOL对话时遇到的障碍。
Though most patients wish to discuss end-of-life (EOL) issues, doctors are reluctant to conduct end-of-life conversations. Little is known about the barriers doctors face in conducting effective EOL conversations with diverse patients. This mixed methods study was undertaken to empirically identify barriers faced by doctors (if any) in conducting effective EOL conversations with diverse patients and to determine if the doctors’ age, gender, ethnicity and medical sub-specialty influenced the barriers reported. Mixed-methods study of multi-specialty doctors caring for diverse, seriously ill patients in two large academic medical centers at the end of the training; data were collected from 2010 to 2012. Doctor-reported barriers to EOL conversations with diverse patients. 1040 of 1234 potential subjects (84.3%) participated. 29 participants were designated as the development cohort for coding and grounded theory analyses to identify primary barriers. The codes were validated by analyses of responses from 50 randomly drawn subjects from the validation cohort (n= 996 doctors). Qualitative responses from the validation cohort were coded and analyzed using quantitative methods. Only 0.01 % doctors reported no barriers to conducting EOL conversations with patients. 99.99% doctors reported barriers with 85.7% finding it very challenging to conduct EOL conversations with all patients and especially so with patients whose ethnicity was different than their own. Asian-American doctors reported the most struggles (91.3%), followed by African Americans (85.3%), Caucasians (83.5%) and Hispanic Americans (79.3%) in conducting EOL conversations with their patients. The biggest doctor-reported barriers to effective EOL conversations are (i) language and medical interpretation issues, (ii) patient/family religio-spiritual beliefs about death and dying, (iii) doctors’ ignorance of patients’ cultural beliefs, values and practices, (iv) patient/family's cultural differences in truth handling and decision making, (v) patients’ limited health literacy and (vi) patients’ mistrust of doctors and the health care system. The doctors' ethnicity (Chi-Square = 12.77, DF = 4, p = 0.0125) and medical subspecialty (Chi-Square = 19.33, DF = 10, p =0.036) influenced their reported barriers. Friedman’s test used to examine participants relative ranking of the barriers across sub-groups identified significant differences by age group (F statistic = 303.5, DF = 5, p < 0.0001) and medical sub-specialty (F statistic =163.7, DF = 5, p < 0.0001). Doctors report struggles with conducting effective EOL conversations with all patients and especially with those whose ethnicity is different from their own. It is vital to identify strategies to mitigate barriers doctors encounter in conducting effective EOL conversations with seriously ill patients and their families.
登录
查看更多内容
DOI：
10.1046/j.1365-2389.2003.51310.x
发表时间：
2003-07-01
影响因子：
6.3
作者：
Greiner, KA;Perera, S;Ahluwalia, JS
通讯作者：
Ahluwalia, JS
影响因子：
6.2
作者：
Buss, Mary K.;Lessen, David S.;Block, Susan D.
通讯作者：
Block, Susan D.
影响因子：
--
作者：
Friedman, M
通讯作者：
Friedman, M
影响因子：
--
作者：
Givens, Jane L.;Tjia, Jennifer;Ash, Arlene S.
通讯作者：
Ash, Arlene S.
影响因子：
--
作者：
MANN, HB;WHITNEY, DR
通讯作者：
WHITNEY, DR