title: Barriers to goals of care discussions with hospitalized patients with advanced heart failure: feasibility and performance of a novel questionnaire.
abstract: OBJECTIVE
  Good end-of-life communication and decision-making are important to patients with advanced heart failure (HF) and their families, but their needs remain unmet. In this pilot study, we describe the feasibility and performance of a novel questionnaire aimed at identifying barriers and solutions to improve communication and decision-making about goals of care for hospitalized patients with advanced HF.
  
  
  METHODS
  We distributed questionnaires to staff cardiologists, cardiology trainees, and cardiology nurses who provide care for HF patients at a Canadian teaching hospital. The questionnaire asked about the importance of various barriers to goals of care discussions. It also asked participants to rank their willingness to engage in goals of care discussions and their views on other clinicians could engage in such discussions.
  
  
  RESULTS
  Of 76 clinicians, 44 (58%) completed the questionnaire (median completion time, 17 min). Individual survey questions had few missing responses (0% to 2%) for questions about barriers to goals of care discussions. There was appreciable discrimination of the importance of different barriers (mean scores 2.2 to 6.0 on a 7-point scale). Preliminary data suggest that clinicians perceive patient and family factors, such as difficulty accepting a poor prognosis, as the most important barriers preventing goals of care discussions.
  
  
  CONCLUSIONS
  In this pilot study, we have demonstrated the feasibility of a novel questionnaire to be used in a larger multi-centre study of end-of-life HF care. Essential information will be obtained to inform the design and evaluation of interventions that seek to improve communication and decision-making about goals of care with HF patients.
authors.affiliation: Department of Medicine University of Ottawa Ottawa Ontario Canada.
authors.forename: Natasha
authors.initials: N
authors.lastname: Aleksova
authors.affiliation: Department of Medicine McMaster University Hamilton Ontario Canada.
authors.forename: Catherine
authors.initials: C
authors.lastname: Demers
authors.affiliation: School of Nursing McMaster University Hamilton Ontario Canada.
authors.forename: Patricia H
authors.initials: PH
authors.lastname: Strachan
authors.affiliation: Faculty of Nursing University of Toronto Toronto Ontario Canada.
authors.forename: Jane
authors.initials: J
authors.lastname: MacIver
authors.affiliation: Interdepartmental Division of Critical Care, Department of Medicine University of Toronto Toronto Ontario Canada.
authors.forename: James
authors.initials: J
authors.lastname: Downar
authors.affiliation: Interdepartmental Division of Critical Care, Department of Medicine University of Toronto Toronto Ontario Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Fowler
authors.affiliation: Clinical Evaluation Research Unit, Department of MedicineKingston General HospitalKingstonOntarioCanada; Department of Community Health and EpidemiologyQueen's UniversityKingstonOntarioCanada.
authors.forename: Daren K
authors.initials: DK
authors.lastname: Heyland
authors.affiliation: Division of Cardiology, Department of Medicine University of Toronto Toronto Ontario Canada.
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Ross
authors.affiliation: Department of MedicineMcMaster UniversityHamiltonOntarioCanada; Department of Clinical Epidemiology and BiostatisticsMcMaster UniversityHamiltonOntarioCanada.
authors.forename: John J
authors.initials: JJ
authors.lastname: You
keywords: Communication; Decision‐making; End‐of‐life care; Goals of care; Heart failure