title: Barriers and facilitators for goals of care discussions between residents and hospitalised patients.
abstract: OBJECTIVE
  To observe how residents are engaging in goals of care discussions with patients and identify thematic patterns that inhibited (barriers) and promoted discussion (facilitators) about goals of care.
  
  
  METHODS
  Admission encounters between residents and patients admitted to a tertiary care academic hospital were recorded and analysed using a qualitative descriptive method. Patients included in the study were individuals over the age of 65 being admitted to the internal medicine service. Residents were eligible if they were trainees in family medicine, emergency medicine, general surgery or internal medicine who were on call for the inpatient medicine rotation.
  
  
  RESULTS
  A total of 15 resident-patient encounters were recorded and analysed, of which 12 encounters included a goals of care discussion. Barriers to goals of care discussions were due to missed opportunities to clarify patient's preferences for life-sustaining treatment and missed opportunities to engage the patient in further discussion. Facilitators to goals of care discussions were use of simple language and exploration of patient's previous experiences with life-sustaining treatment.
  
  
  CONCLUSIONS
  Asking about patients' previous experiences with life support can be an effective strategy to gauge the patient's understanding and goals of care preferences. This knowledge can improve residents' skill in communicating with their patients about goals of care and inform future education initiatives.
authors.affiliation: Department of Medicine, McMaster University, Hamilton, Ontario, Canada.|Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Kalpa
authors.initials: K
authors.lastname: Shah
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Swinton
authors.affiliation: Department of Medicine, McMaster University, Hamilton, Ontario, Canada.|Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: John J
authors.initials: JJ
authors.lastname: You
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007297:Inpatients; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D008297:Male; D008505:Medical Staff, Hospital; D010347:Patient Care Planning; D010817:Physician-Patient Relations
keywords: Goals of care, resident, communication, death; code status; resuscitation