Communication Training and Code Status Conversation Patterns Reported by Emergency Clinicians

Thidathit Prachanukool; Emily L Aaronson; Joshua R Lakin; Masaya Higuchi; Rachel S Lee; Ilianna Santangelo; Mohammad A Hasdianda; Wei Wang; Naomi George; Shan W Liu; Maura Kennedy; Mara A Schonberg; Susan D Block; James A Tulsky; Kei Ouchi

doi:10.1016/j.jpainsymman.2022.10.006

Communication Training and Code Status Conversation Patterns Reported by Emergency Clinicians

J Pain Symptom Manage. 2023 Jan;65(1):58-65. doi: 10.1016/j.jpainsymman.2022.10.006. Epub 2022 Oct 17.

Authors

Affiliations

¹ Department of Emergency Medicine (T.P., R.S.L., M.A.H., K.O.), Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School (T.P., E.L.A., J.R.L., M.A.H., S.W.L., M.K., M.A.S., S.D.B., J.A.T., K.O.), Boston, Massachusetts, USA; Department of Emergency Medicine (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. Electronic address: tprachanukool@bwh.harvard.edu.
² Harvard Medical School (T.P., E.L.A., J.R.L., M.A.H., S.W.L., M.K., M.A.S., S.D.B., J.A.T., K.O.), Boston, Massachusetts, USA; Department of Emergency Medicine (E.L.A., I.S., S.W.L., M.K.), Massachusetts General Hospital, Boston, Massachusetts, USA.
³ Harvard Medical School (T.P., E.L.A., J.R.L., M.A.H., S.W.L., M.K., M.A.S., S.D.B., J.A.T., K.O.), Boston, Massachusetts, USA; Serious Illness Care Program (J.R.L., K.O.), Ariadne Labs, Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care (J.R.L., S.D.B., J.A.T., K.O.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
⁴ Palliative Care and Geriatric Medicine (M.H.), Massachusetts General Hospital, Boston, Massachusetts, USA.
⁵ Department of Emergency Medicine (T.P., R.S.L., M.A.H., K.O.), Brigham and Women's Hospital, Boston, Massachusetts, USA.
⁶ Department of Emergency Medicine (E.L.A., I.S., S.W.L., M.K.), Massachusetts General Hospital, Boston, Massachusetts, USA.
⁷ Department of Emergency Medicine (T.P., R.S.L., M.A.H., K.O.), Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School (T.P., E.L.A., J.R.L., M.A.H., S.W.L., M.K., M.A.S., S.D.B., J.A.T., K.O.), Boston, Massachusetts, USA.
⁸ Department of Medicine and Neurology, Brigham and Women's Hospital (W.W.), Boston, Massachusetts, USA.
⁹ Department of Emergency Medicine `(N.G.), Division of Critical Care, University of New Mexico, Albuquerque, New Mexico, USA.
¹⁰ Harvard Medical School (T.P., E.L.A., J.R.L., M.A.H., S.W.L., M.K., M.A.S., S.D.B., J.A.T., K.O.), Boston, Massachusetts, USA; Department of Medicine (M.A.S.), Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
¹¹ Harvard Medical School (T.P., E.L.A., J.R.L., M.A.H., S.W.L., M.K., M.A.S., S.D.B., J.A.T., K.O.), Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care (J.R.L., S.D.B., J.A.T., K.O.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Departments of Medicine (S.D.B., J.A.T.), Brigham and Women's Hospital, Boston, Massachusetts, USA.
¹² Department of Emergency Medicine (T.P., R.S.L., M.A.H., K.O.), Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School (T.P., E.L.A., J.R.L., M.A.H., S.W.L., M.K., M.A.S., S.D.B., J.A.T., K.O.), Boston, Massachusetts, USA; Serious Illness Care Program (J.R.L., K.O.), Ariadne Labs, Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care (J.R.L., S.D.B., J.A.T., K.O.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA.

Abstract

Context: During acute health decompensations for seriously ill patients, emergency clinicians often determine the intensity end-of-life care. Little is known about how emergency clinicians conduct these conversations, especially among those who have received serious illness communication training.

Objectives: To determine the self-reported practice patterns of code status conversations by emergency clinicians with and without serious illness communication training.

Methods: A cross-sectional survey was conducted among emergency clinicians with and without a recent evidence-based, serious illness communication training tailored for emergency clinicians. Emergency clinicians were included from two academic medical centers. A five-point Likert scale ("very unlikely" to "very likely" to ask) was used to assess the self-reported likelihood of asking about patients' preferences for medical procedures and patients' values and goals.

Results: Among 161 respondents (71% response rate), 77 (48%) received the training. A total of 70% of emergency clinicians reported asking about procedure-based questions, and only 38% reported asking about patient's values regarding end-of-life care. For value-based questions, statistically significant differences were observed between emergency clinicians who underwent the training and those who did not in four of the seven questions asked (e.g., the higher odds of exploring the patient's life priorities [adjusted OR = 4.34, 95% CI = 1.95-9.65, P-value < 0.001]). No difference was observed in the self-reported rates of all procedure-based questions between the two groups.

Conclusion: Most emergency clinicians reported asking about procedure-based questions, and some asked about patient's value-based questions. Clinicians with recent serious illness communication training may ask more about some values and priorities.

Keywords: Serious illness communication; communication training; emergency department; emergency medicine; palliative care.

Publication types

Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

MeSH terms

Communication
Critical Illness*
Cross-Sectional Studies
Humans
Self Report
Terminal Care* / methods

Abstract

Publication types

MeSH terms

Grants and funding