Communication Training and Code Status Conversation Patterns Reported by Emergency Clinicians

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.