Abstract
Care Decision Conversations: Improving communication about treatment wishes and limitations: how to prepare patients and physicians
In our thesis, we explore how to enhance conversations about care decisions between doctors and patients, to adjust treatment to the patients’ goals, wishes and values. We developed training programs for physicians and educational materials for patients, testing these interventions in both outpatient clinics and emergency departments. Besides, we analyzed conversations and performed interviews with patients and physicians to gain insight in the current practice.
Current Practices and Challenges: Care decision conversations occur rarely. There is no dedicated slot for the introduction of the topic of care decisions. Physicians use extensive justifications for the introduction of the topic and express troubles to introduce it without clear direct cause. The topic is sensitive, what can be seen by the use of hesitations and repairs when it is introduced. Patients associate the topic with the end of life, and therefore irrelevant for them at this moment. They wait for doctors to initiate care decision conversations.
Effect of the interventions: Physicians feel better prepared for care decision conversations after training. Patients assessed the educational material informative. At the outpatient clinic, patient satisfaction did not improve after the interventions, perhaps because overall satisfaction was already very high. At the emergency department, quality of care decision conversations, assessed by patients, improved significantly, despite merely 12% of the patients received the educational folder. This suggest the physician training mainly caused the improvement.
Recommendations: We recommend for the integration of care decision conversations in medical consults: a normal, recurring part of the conversation. Training for physicians should focus on the relevance and sensitivity of the topic, and conversational techniques. Patients should be made aware of the relevance and the topic should be disconnected from the end of life.
Together, patients and physicians can make way for fruitful care decision conversations!
In our thesis, we explore how to enhance conversations about care decisions between doctors and patients, to adjust treatment to the patients’ goals, wishes and values. We developed training programs for physicians and educational materials for patients, testing these interventions in both outpatient clinics and emergency departments. Besides, we analyzed conversations and performed interviews with patients and physicians to gain insight in the current practice.
Current Practices and Challenges: Care decision conversations occur rarely. There is no dedicated slot for the introduction of the topic of care decisions. Physicians use extensive justifications for the introduction of the topic and express troubles to introduce it without clear direct cause. The topic is sensitive, what can be seen by the use of hesitations and repairs when it is introduced. Patients associate the topic with the end of life, and therefore irrelevant for them at this moment. They wait for doctors to initiate care decision conversations.
Effect of the interventions: Physicians feel better prepared for care decision conversations after training. Patients assessed the educational material informative. At the outpatient clinic, patient satisfaction did not improve after the interventions, perhaps because overall satisfaction was already very high. At the emergency department, quality of care decision conversations, assessed by patients, improved significantly, despite merely 12% of the patients received the educational folder. This suggest the physician training mainly caused the improvement.
Recommendations: We recommend for the integration of care decision conversations in medical consults: a normal, recurring part of the conversation. Training for physicians should focus on the relevance and sensitivity of the topic, and conversational techniques. Patients should be made aware of the relevance and the topic should be disconnected from the end of life.
Together, patients and physicians can make way for fruitful care decision conversations!
| Original language | English |
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| Awarding Institution |
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| Award date | 30 Sept 2024 |
| Place of Publication | Utrecht |
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| Print ISBNs | 978-90-393-7708-6 |
| DOIs | |
| Publication status | Published - 30 Sept 2024 |
Keywords
- care decisions
- patient education
- physician education
- communication
- treatment wishes and boundaries