Cultural Adaptation and Acceptability of the Crisis Conversation Guide by Emergency Physicians for Serious Illness Patients: Mixed Methods Study

Abstract

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.