Browsing by Author "Kahapana S."

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    Comparing approaches to code status conversations between Thai and American emergency clinicians: a survey study
    (2025-01-01) Prachanukool T.; Atiksawedparit P.; Senasu S.; Mitsungnern T.; Trinarongsakul T.; Wongjittraporn S.; Oelschlager H.; Kahapana S.; Ouchi K.; Prachanukool T.; Mahidol University
    Objectives Emergency clinicians conduct code status conversations as part of shared decision-making regarding the management of patients with serious life-limiting illnesses. Given that varying sociocultural norms and healthcare systems affect communication, we hypothesised that American and Thai emergency clinicians report different approaches to code status conversations. Methods A cross-sectional survey study was conducted in one US hospital and four Thai hospitals from December 2021 to November 2022. Using a 5-point Likert Scale, the survey questions focused on clinical practice for procedure-based and value-based components of code status conversations. We developed the survey from a medical communication expert team and then reviewed, refined and validated the questions. Multiple logistic regression analysis was used to compare the asking in code status conversation among American and Thai emergency clinicians and controlled for potential confounding variables. Results We received responses from 84 American and 81 Thai emergency clinicians (74% and 70%, respectively). Most of the participants had 6–10 years of clinical experience (n=71, 43%), had code status conversations more than twice each month (n=63, 38%), and had prior palliative care training (n=141, 86%). Over 50% of all emergency clinicians responded’very likely’ or’somewhat likely’ to incorporate all six procedure-based components but only one of the six value-based components. Compared with Thai emergency clinicians, American emergency clinicians were significantly more likely to ask one procedure-based component (restarting the patient’s heart, adjusted OR (aOR) =9.3 (95% CI 3.2 to 26.8)), while less likely to ask another procedure-based component (the patient’s preference for vasopressors, aOR=0.3 (95% CI 0.1 to 0.7)), and two value-based components (providing a recommendation, aOR=0.2 (95% CI 0.1 to 0.5), assessing the patient’s baseline activity, aOR=0.2 (95% CI 0.1 to 0.4)). Conclusion In the approaches to code status conversations, American and Thai emergency clinicians collectively report asking about procedures rather than personal values, while specific distinctions exist and potentially reflect different cultural approaches.
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    Cultural Adaptation and Acceptability of the Crisis Conversation Guide by Emergency Physicians for Serious Illness Patients: Mixed Methods Study
    (2025-12-01) Prachanukool T.; Trinarongsakul T.; Mitsungnern T.; Pongsettakul N.; Raksasataya A.; Wongtangman T.; Nagaviroj K.; Chanthong P.; Kahapana S.; Oelschlager H.; Stonington S.D.; Ouchi K.; Prachanukool T.; Mahidol University
    Background: During a medical crisis, emergency physicians often discuss life-saving interventions with seriously ill patients and their families. Crisis conversations require strong communication skills and a patient-centered approach. Objective: To culturally adapt and assess the acceptability of an existing English crisis conversation guide for use by emergency physicians in Thailand. Materials and Methods: A three-stage mixed-method study was conducted. The initial stage included the translation and cultural adaptation of an English crisis conversation guide to Thai using a modified Delphi method with an expert panel’s consensus. The expert panel included four emergency physicians and four palliative care clinicians. The second stage involved surveying Thai emergency physicians on the perceived necessity of each step of the conversation guide using a 5-point Likert scale. In the third stage, the expert panel reviewed the survey results and incorporated feedback to produce the final Thai crisis conversation guide. Results: The Thai crisis conversation guide was initially adapted from the English original via Thai word adaptation and practical rearrangement. In the refinement stage, the expert panel modified several strategies for exploring patient values and added a new step to the conversation guide, which the authors term “gathering the decision makers”. The acceptability survey was completed by 180 Thai emergency physicians, with a 36% response rate. These physicians reported that the step with the strongest perceived necessity in the conversation guide was “summarize goal of care” with 176 participants (98%) responding “agree” and “strongly agree”. Conclusion: The crisis conversation guide was culturally adapted for clinical practice in Thailand. More than 88% of Thai emergency physicians reported the conversation guide to be acceptable in their clinical practice.