title: Clinician Perspectives on Challenges to Patient Centered Care at the End of Life.
abstract: Discussions regarding patient preferences for resuscitation are often delayed and preferences may be neglected, leading to the receipt of unwanted medical care. To better understand barriers to the expression and realization of patients' end of life wishes, a preventive ethics team in one Veterans Affairs Medical Center conducted a survey of physicians, nurses, social workers, and respiratory therapists. Surveys were analyzed through qualitative analysis, using sorting methodologies to identify themes. Analysis revealed barriers to patient wishes being identified and followed, including discomfort conducting end-of-life discussions, difficulty locating patients' preferences in medical records, challenges with expiring do not resuscitate (DNR) orders, and confusion over terminology. Based on these findings, the preventive ethics team proposed new terminology for code status preferences, elimination of the local policy for expiration of DNR orders, and enhanced systems for storing and retrieving patients' end-of-life preferences. Educational efforts were initiated to facilitate implementation of the proposed changes.
authors.affiliation: 1 Lexington Veterans Affairs Medical Center, Lexington, KY, USA.
authors.forename: Shoshana H
authors.initials: SH
authors.lastname: Bardach
authors.affiliation: 1 Lexington Veterans Affairs Medical Center, Lexington, KY, USA.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Dunn
authors.affiliation: 2 University of Kentucky, Lexington, KY, USA.
authors.forename: J Christopher
authors.initials: JC
authors.lastname: Stein
mesh_terms: D001291:Attitude of Health Personnel; D006801:Humans; D007629:Kentucky; D010347:Patient Care Planning; D057240:Patient Preference; D018802:Patient-Centered Care; D010817:Physician-Patient Relations; D036301:Qualitative Research; D016414:Resuscitation Orders / Q000331:legislation & jurisprudence*; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000941:ethics*; D009626:Terminology as Topic
keywords: end of life; ethics; patient care planning; qualitative research