title: Confidence with and Barriers to Serious Illness Communication: A National Survey of Hospitalists.
abstract: To describe the concerns, confidence, and barriers of practicing hospitalists around serious illness communication.
  
  
  
  Hospitalist physicians are optimally positioned to provide primary palliative care, yet their experiences in serious illness communication are not well described.
  
  
  
  Web-based survey, conducted in May 2016. The survey link was distributed via email to 4000 members of the Society of Hospital Medicine. The 39-item survey assessed frequency of concerns about serious illness communication, confidence for common tasks, and barriers using Likert-type scales. It was developed by the authors based on prior work, a focus group, and feedback from pilot respondents.
  
  
  
  We received 332 completed surveys. On most or every shift, many participants reported having concerns about a patient's or family's understanding of prognosis (53%) or the patient's code status (63%). Most participants were either confident or very confident in discussing goals of care (93%) and prognosis (87%). Fewer were confident or very confident in responding to patients or families who had not accepted the seriousness of an illness (59%) or in managing conflict (50%). Other frequently cited barriers were lack of time, lack of prior discussions in the outpatient setting, unrealistic prognostic expectations from other physicians, limited institutional support, and difficulty finding records of previous discussions.
  
  
  
  Our results suggest opportunities to improve hospitalists' ability to lead serious illness communication by increasing the time hospitalists have for discussions, improving documentation systems and communication between inpatient and outpatient clinicians, and targeted training on challenging communication scenarios.
authors.affiliation: 1 Division of Palliative Care, Massachusetts General Hospital , Boston, Massachusetts.
authors.forename: Leah B
authors.initials: LB
authors.lastname: Rosenberg
authors.affiliation: 2 Core Educator Faculty, Department of Medicine, Massachusetts General Hospital , Boston, Massachusetts.
authors.forename: Jeff
authors.initials: J
authors.lastname: Greenwald
authors.affiliation: 3 Division of Hospital Medicine, University of Wisconsin , School of Medicine and Public Health, Madison, Wisconsin.
authors.forename: Bartho
authors.initials: B
authors.lastname: Caponi
authors.affiliation: 4 Division of Pediatric Hospital Medicine, Rady Children's Hospital and University of California , San Diego, California.
authors.forename: Ami
authors.initials: A
authors.lastname: Doshi
authors.affiliation: 5 Board of Directors, Society of Hospital Medicine , Philadelphia, Pennsylvania.
authors.forename: Howard
authors.initials: H
authors.lastname: Epstein
authors.affiliation: 6 CEP America , Emeryville, California.
authors.forename: Jeff
authors.initials: J
authors.lastname: Frank
authors.affiliation: 7 Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai , New York, New York.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lindenberger
authors.affiliation: 8 Society of Hospital Medicine , Philadelphia, Pennsylvania.
authors.forename: Nick
authors.initials: N
authors.lastname: Marzano
authors.affiliation: 9 Division of Hospital Medicine, University of California , San Francisco, California.
authors.forename: Lynnea M
authors.initials: LM
authors.lastname: Mills
authors.affiliation: 10 Palliative Medicine Program, Division of General Internal Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland.
authors.forename: Rab
authors.initials: R
authors.lastname: Razzak
authors.affiliation: 11 Department of Hospital Medicine, Regions Hospital , St Paul, Minnesota.
authors.forename: James
authors.initials: J
authors.lastname: Risser
authors.affiliation: 9 Division of Hospital Medicine, University of California , San Francisco, California.|12 Palliative Care Program, University of California , San Francisco, California.|13 Department of Physiological Nursing, University of California San Francisco School of Nursing , San Francisco, California.
authors.forename: Wendy G
authors.initials: WG
authors.lastname: Anderson
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003144:Communication Barriers; D017144:Focus Groups; D020445:Hospitalists / Q000523:psychology*; D006801:Humans; D008875:Middle Aged; D010166:Palliative Care; D011369:Professional-Patient Relations; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
keywords: hospitalists; serious illness communication; survey research