Sökning: id:"swepub:oai:lup.lub.lu.se:fe94cd39-ff12-4c8c-8f74-1c546a71e9ad" >
Improving serious i...
Improving serious illness communication : a qualitative study of clinical culture
-
- Paladino, Joanna (författare)
- Massachusetts General Hospital,Harvard Medical School
-
- Sanders, Justin J. (författare)
- McGill University
-
- Fromme, Erik K. (författare)
- Harvard Medical School,Dana-Farber Cancer Institute
-
visa fler...
-
- Block, Susan (författare)
- Harvard Medical School,Dana-Farber Cancer Institute
-
- Jacobsen, Juliet C. (författare)
- Lund University,Lunds universitet,Lungmedicin, allergologi och palliativ medicin,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Palliativt Utvecklingscentrum,Forskargrupper vid Lunds universitet,Respiratory Medicine, Allergology, and Palliative Medicine,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,The Institute for Palliative Care,Lund University Research Groups,Massachusetts General Hospital
-
- Jackson, Vicki A. (författare)
- Harvard Medical School,Massachusetts General Hospital
-
- Ritchie, Christine S. (författare)
- Massachusetts General Hospital,Harvard Medical School
-
Mitchell, Suzanne (författare)
-
visa färre...
-
(creator_code:org_t)
- 2023
- 2023
- Engelska.
-
Ingår i: BMC Palliative Care. - 1472-684X. ; 22:1
- Relaterad länk:
-
http://dx.doi.org/10... (free)
-
visa fler...
-
https://lup.lub.lu.s...
-
https://doi.org/10.1...
-
visa färre...
Abstract
Ämnesord
Stäng
- Objective: Communication about patients’ values, goals, and prognosis in serious illness (serious illness communication) is a cornerstone of person-centered care yet difficult to implement in practice. As part of Serious Illness Care Program implementation in five health systems, we studied the clinical culture-related factors that supported or impeded improvement in serious illness conversations. Methods: Qualitative analysis of semi-structured interviews of clinical leaders, implementation teams, and frontline champions. Results: We completed 30 interviews across palliative care, oncology, primary care, and hospital medicine. Participants identified four culture-related domains that influenced serious illness communication improvement: (1) clinical paradigms; (2) interprofessional empowerment; (3) perceived conversation impact; (4) practice norms. Changes in clinicians’ beliefs, attitudes, and behaviors in these domains supported values and goals conversations, including: shifting paradigms about serious illness communication from ‘end-of-life planning’ to ‘knowing and honoring what matters most to patients;’ improvements in psychological safety that empowered advanced practice clinicians, nurses and social workers to take expanded roles; experiencing benefits of earlier values and goals conversations; shifting from avoidant norms to integration norms in which earlier serious illness discussions became part of routine processes. Culture-related inhibitors included: beliefs that conversations are about dying or withdrawing care; attitudes that serious illness communication is the physician’s job; discomfort managing emotions; lack of reliable processes. Conclusions: Aspects of clinical culture, such as paradigms about serious illness communication and inter-professional empowerment, are linked to successful adoption of serious illness communication. Further research is warranted to identify effective strategies to enhance clinical culture and drive clinician practice change.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Hälsovetenskap -- Omvårdnad (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Health Sciences -- Nursing (hsv//eng)
Nyckelord
- Clinical culture
- Goals of care
- Patient-provider communication
- Quality improvement
- Serious illness communication
Publikations- och innehållstyp
- art (ämneskategori)
- ref (ämneskategori)
Hitta via bibliotek
Till lärosätets databas