Strategies for effective goals of care discussions and decision-making: perspectives from a multi-centre survey of Canadian hospital-based healthcare providers.
BACKGROUND
Communication gaps impact the quality of patient care. Previous research has focused on communication barriers rather than seeking solutions. Our aim was to identify strategies for effective communication and decision-making about goals of care for medical interventions in serious illness, from the perspectives of hospital-based healthcare providers.


METHODS
A cross-sectional survey composed of closed- and open-ended questions about goals of care communication and decision-making was administered to healthcare providers in 13 centres in six Canadian provinces. We analyzed a portion of the open-ended survey questions, specifically (1) suggestions for overcoming barriers encountered in discussing goals of care, and (2) currently effective practices. Thematic content analysis was used to analyze responses to the open-ended questions.


RESULTS
Of the 1,256 respondents to the larger survey, 468 responded to the open-ended questions (37%), including 272 of 512 nurses (53%), 153 of 484 internal medicine trainees (32%), and 43 of 260 attending physicians (17%). Responses to each of the two questions were similar, generating a common set of themes and subthemes. Effective strategies and ideas for improving communication and decision-making about goals of care clustered under five themes: patient and family factors, communication between healthcare providers and patients, interprofessional collaboration, education, and resources. Subthemes highlighted core elements of shared decision-making.


CONCLUSIONS
Translating our findings into multifaceted interventions that consider patient and family factors, address knowledge gaps, optimize resource utilization, and facilitate communication and collaboration between patients, families and healthcare providers may improve communication and decision-making about goals of care.
Department of Critical Care Medicine and Division of Palliative Medicine, University of Calgary, South Health Campus, 4448 Front St SE, Calgary, AB, T3M 1M4, Canada. amanda.rozedesordons@ucalgary.ca.
Amanda L
AL
Roze des Ordons
W21C (Ward of the 21st Century), Cumming School of Medicine, University of Calgary, GD01 TRW Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada. nishan.sharma@ucalgary.ca.
Nishan
N
Sharma
Critical Care Programme, Queen's University, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada. dkh2@queensu.ca.
Daren K
DK
Heyland
Departments of Medicine and Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Room HSC-2C8, Hamilton, ON, L8S 4K1, Canada. jyou@mcmaster.ca.
John J
JJ
You
D002170:Canada; D003142:Communication; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D003657:Decision Making; D006282:Health Personnel; D006761:Hospitals / Q000592:standards*; D006801:Humans; D010347:Patient Care Planning / Q000592:standards*; D011795:Surveys and Questionnaires