title: Barriers to communication regarding end-of-life care: perspectives of care providers.
abstract: OBJECTIVE
  Communication regarding end-of-life care is frequently perceived as suboptimal, despite the intent of both health care providers and patients. We interviewed health care providers to determine their perspective regarding these barriers to communication.
  
  
  METHODS
  Eleven focus groups with a total of 10 attending physicians, 24 residents, and 33 nurses were convened to explore barriers to end-of-life discussions on the Internal Medicine service at a 600-bed tertiary care hospital in Toronto, Canada. An interview schedule was designed to elicit information regarding the process of end-of-life discussions, barriers to these discussions, and possible interventions for limiting such barriers. Transcripts were qualitatively analyzed by 6 raters who independently identified "themes." Themes were refined using the Delphi technique and classified under broader "categories."
  
  
  RESULTS
  Four main categories of barriers emerged, relating to (1) patients, (2) the health care system, (3) health care providers, and (4) the nature of this dialogue. Attending physicians and residents most frequently identified patient-related factors as barriers to discussions, followed by system, dialogue, and provider barriers (43%, 39%, 10%, and 8%, respectively, for attending physicians; 40%, 34%, 13%, and 13%, respectively, for residents). Nurses similarly identified patient-related and system barriers most frequently, but provider barriers were discussed more often than dialogue barriers (46%, 28%, 22%, and 4%, respectively).
  
  
  CONCLUSIONS
  Attending physicians, residents, and nurses perceive the recipients of their care, and the system within which they provide this care, to be the major source of barriers to communication regarding end-of-life care. This finding may impact on the effectiveness of quality-improvement initiatives in end-of-life care.
authors.affiliation: Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada K1H 8M5.
authors.forename: Anjali H
authors.initials: AH
authors.lastname: Anselm
authors.forename: Valerie
authors.initials: V
authors.lastname: Palda
authors.forename: Cameron B
authors.initials: CB
authors.lastname: Guest
authors.forename: Richard F
authors.initials: RF
authors.lastname: McLean
authors.forename: Mary L S
authors.initials: ML
authors.lastname: Vachon
authors.forename: Merrijoy
authors.initials: M
authors.lastname: Kelner
authors.forename: Jenny
authors.initials: J
authors.lastname: Lam-McCulloch
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003144:Communication Barriers; D003466:Cultural Characteristics; D003657:Decision Making; D005190:Family / Q000523:psychology; D005260:Female; D017144:Focus Groups; D006801:Humans; D007297:Inpatients / Q000523:psychology; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology*; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000523:psychology*; D011369:Professional-Patient Relations