The differences in code status conversation approaches reported by emergency medicine and palliative care clinicians: A mixed-method study
Issued Date
2023-01-01
Resource Type
ISSN
10696563
eISSN
15532712
Scopus ID
2-s2.0-85175376070
Pubmed ID
37814372
Journal Title
Academic Emergency Medicine
Rights Holder(s)
SCOPUS
Bibliographic Citation
Academic Emergency Medicine (2023)
Suggested Citation
Ouchi K., Prachanukool T., Aaronson E.L., Lakin J.R., Higuchi M., Liu S.W., Kennedy M., Revette A.C., Chary A.N., Kaithamattam J., Lee B., Neville T.H., Hasdianda M.A., Sudore R., Schonberg M.A., Tulsky J.A., Block S.D. The differences in code status conversation approaches reported by emergency medicine and palliative care clinicians: A mixed-method study. Academic Emergency Medicine (2023). doi:10.1111/acem.14818 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/90971
Title
The differences in code status conversation approaches reported by emergency medicine and palliative care clinicians: A mixed-method study
Author's Affiliation
Ariadne Labs
UCSF School of Medicine
Beth Israel Deaconess Medical Center
Massachusetts General Hospital
Brigham and Women's Hospital
Faculty of Medicine Ramathibodi Hospital, Mahidol University
Dana-Farber Cancer Institute
David Geffen School of Medicine at UCLA
Harvard Medical School
Baylor College of Medicine
UCSF School of Medicine
Beth Israel Deaconess Medical Center
Massachusetts General Hospital
Brigham and Women's Hospital
Faculty of Medicine Ramathibodi Hospital, Mahidol University
Dana-Farber Cancer Institute
David Geffen School of Medicine at UCLA
Harvard Medical School
Baylor College of Medicine
Other Contributor(s)
Abstract
Background: During acute health deterioration, emergency medicine and palliative care clinicians routinely discuss code status (e.g., shared decision making about mechanical ventilation) with seriously ill patients. Little is known about their approaches. We sought to elucidate how code status conversations are conducted by emergency medicine and palliative care clinicians and why their approaches are different. Methods: We conducted a sequential-explanatory, mixed-method study in three large academic medical centers in the Northeastern United States. Attending physicians and advanced practice providers working in emergency medicine and palliative care were eligible. Among the survey respondents, we purposefully sampled the participants for follow-up interviews. We collected clinicians’ self-reported approaches in code status conversations and their rationales. A survey with a 5-point Likert scale (“very unlikely” to “very likely”) was used to assess the likelihood of asking about medical procedures (procedure based) and patients’ values (value based) during code status conversations, followed by semistructured interviews. Results: Among 272 clinicians approached, 206 completed the survey (a 76% response rate). The reported approaches differed greatly (e.g., 91% of palliative care clinicians reported asking about a patient's acceptable quality of life compared to 59% of emergency medicine clinicians). Of the 206 respondents, 118 (57%) agreed to subsequent interviews; our final number of semistructured interviews included seven emergency medicine clinicians and nine palliative care clinicians. The palliative care clinicians stated that the value-based questions offer insight into patients’ goals, which is necessary for formulating a recommendation. In contrast, emergency medicine clinicians stated that while value-based questions are useful, they are vague and necessitate extended discussions, which are inappropriate during emergencies. Conclusions: Emergency medicine and palliative care clinicians reported conducting code status conversations differently. The rationales may be shaped by their clinical practices and experiences.
