Confidence with and Barriers to Serious Illness Communication: A National Survey of Hospitalists

Leah B. Rosenberg, Jeff Greenwald, Bartho Caponi, Ami Doshi, Howard Epstein, Jeff Frank, Elizabeth Lindenberger, Nick Marzano, Lynnea M. Mills, Abdul Rab Razzak, James Risser, Wendy G. Anderson

Research output: Contribution to journalReview article

Abstract

Objective: To describe the concerns, confidence, and barriers of practicing hospitalists around serious illness communication. Background: Hospitalist physicians are optimally positioned to provide primary palliative care, yet their experiences in serious illness communication are not well described. Methods: Web-based survey, conducted in May 2016. The survey link was distributed via email to 4000 members of the Society of Hospital Medicine. The 39-item survey assessed frequency of concerns about serious illness communication, confidence for common tasks, and barriers using Likert-type scales. It was developed by the authors based on prior work, a focus group, and feedback from pilot respondents. Results: We received 332 completed surveys. On most or every shift, many participants reported having concerns about a patient's or family's understanding of prognosis (53%) or the patient's code status (63%). Most participants were either confident or very confident in discussing goals of care (93%) and prognosis (87%). Fewer were confident or very confident in responding to patients or families who had not accepted the seriousness of an illness (59%) or in managing conflict (50%). Other frequently cited barriers were lack of time, lack of prior discussions in the outpatient setting, unrealistic prognostic expectations from other physicians, limited institutional support, and difficulty finding records of previous discussions. Discussion: Our results suggest opportunities to improve hospitalists' ability to lead serious illness communication by increasing the time hospitalists have for discussions, improving documentation systems and communication between inpatient and outpatient clinicians, and targeted training on challenging communication scenarios.

Original languageEnglish (US)
Pages (from-to)1013-1019
Number of pages7
JournalJournal of Palliative Medicine
Volume20
Issue number9
DOIs
StatePublished - Sep 1 2017

Fingerprint

Hospitalists
Communication
Outpatients
Patient Care Planning
Physicians
Aptitude
Focus Groups
Palliative Care
Documentation
Surveys and Questionnaires
Inpatients
Primary Health Care

Keywords

  • hospitalists
  • serious illness communication
  • survey research

ASJC Scopus subject areas

  • Nursing(all)
  • Anesthesiology and Pain Medicine

Cite this

Rosenberg, L. B., Greenwald, J., Caponi, B., Doshi, A., Epstein, H., Frank, J., ... Anderson, W. G. (2017). Confidence with and Barriers to Serious Illness Communication: A National Survey of Hospitalists. Journal of Palliative Medicine, 20(9), 1013-1019. https://doi.org/10.1089/jpm.2016.0515

Confidence with and Barriers to Serious Illness Communication : A National Survey of Hospitalists. / Rosenberg, Leah B.; Greenwald, Jeff; Caponi, Bartho; Doshi, Ami; Epstein, Howard; Frank, Jeff; Lindenberger, Elizabeth; Marzano, Nick; Mills, Lynnea M.; Razzak, Abdul Rab; Risser, James; Anderson, Wendy G.

In: Journal of Palliative Medicine, Vol. 20, No. 9, 01.09.2017, p. 1013-1019.

Research output: Contribution to journalReview article

Rosenberg, LB, Greenwald, J, Caponi, B, Doshi, A, Epstein, H, Frank, J, Lindenberger, E, Marzano, N, Mills, LM, Razzak, AR, Risser, J & Anderson, WG 2017, 'Confidence with and Barriers to Serious Illness Communication: A National Survey of Hospitalists', Journal of Palliative Medicine, vol. 20, no. 9, pp. 1013-1019. https://doi.org/10.1089/jpm.2016.0515
Rosenberg, Leah B. ; Greenwald, Jeff ; Caponi, Bartho ; Doshi, Ami ; Epstein, Howard ; Frank, Jeff ; Lindenberger, Elizabeth ; Marzano, Nick ; Mills, Lynnea M. ; Razzak, Abdul Rab ; Risser, James ; Anderson, Wendy G. / Confidence with and Barriers to Serious Illness Communication : A National Survey of Hospitalists. In: Journal of Palliative Medicine. 2017 ; Vol. 20, No. 9. pp. 1013-1019.
@article{563e8e627665487b8538b264d1a3ee76,
title = "Confidence with and Barriers to Serious Illness Communication: A National Survey of Hospitalists",
abstract = "Objective: To describe the concerns, confidence, and barriers of practicing hospitalists around serious illness communication. Background: Hospitalist physicians are optimally positioned to provide primary palliative care, yet their experiences in serious illness communication are not well described. Methods: Web-based survey, conducted in May 2016. The survey link was distributed via email to 4000 members of the Society of Hospital Medicine. The 39-item survey assessed frequency of concerns about serious illness communication, confidence for common tasks, and barriers using Likert-type scales. It was developed by the authors based on prior work, a focus group, and feedback from pilot respondents. Results: We received 332 completed surveys. On most or every shift, many participants reported having concerns about a patient's or family's understanding of prognosis (53{\%}) or the patient's code status (63{\%}). Most participants were either confident or very confident in discussing goals of care (93{\%}) and prognosis (87{\%}). Fewer were confident or very confident in responding to patients or families who had not accepted the seriousness of an illness (59{\%}) or in managing conflict (50{\%}). Other frequently cited barriers were lack of time, lack of prior discussions in the outpatient setting, unrealistic prognostic expectations from other physicians, limited institutional support, and difficulty finding records of previous discussions. Discussion: Our results suggest opportunities to improve hospitalists' ability to lead serious illness communication by increasing the time hospitalists have for discussions, improving documentation systems and communication between inpatient and outpatient clinicians, and targeted training on challenging communication scenarios.",
keywords = "hospitalists, serious illness communication, survey research",
author = "Rosenberg, {Leah B.} and Jeff Greenwald and Bartho Caponi and Ami Doshi and Howard Epstein and Jeff Frank and Elizabeth Lindenberger and Nick Marzano and Mills, {Lynnea M.} and Razzak, {Abdul Rab} and James Risser and Anderson, {Wendy G.}",
year = "2017",
month = "9",
day = "1",
doi = "10.1089/jpm.2016.0515",
language = "English (US)",
volume = "20",
pages = "1013--1019",
journal = "Journal of Palliative Medicine",
issn = "1096-6218",
publisher = "Mary Ann Liebert Inc.",
number = "9",

}

TY - JOUR

T1 - Confidence with and Barriers to Serious Illness Communication

T2 - A National Survey of Hospitalists

AU - Rosenberg, Leah B.

AU - Greenwald, Jeff

AU - Caponi, Bartho

AU - Doshi, Ami

AU - Epstein, Howard

AU - Frank, Jeff

AU - Lindenberger, Elizabeth

AU - Marzano, Nick

AU - Mills, Lynnea M.

AU - Razzak, Abdul Rab

AU - Risser, James

AU - Anderson, Wendy G.

PY - 2017/9/1

Y1 - 2017/9/1

N2 - Objective: To describe the concerns, confidence, and barriers of practicing hospitalists around serious illness communication. Background: Hospitalist physicians are optimally positioned to provide primary palliative care, yet their experiences in serious illness communication are not well described. Methods: Web-based survey, conducted in May 2016. The survey link was distributed via email to 4000 members of the Society of Hospital Medicine. The 39-item survey assessed frequency of concerns about serious illness communication, confidence for common tasks, and barriers using Likert-type scales. It was developed by the authors based on prior work, a focus group, and feedback from pilot respondents. Results: We received 332 completed surveys. On most or every shift, many participants reported having concerns about a patient's or family's understanding of prognosis (53%) or the patient's code status (63%). Most participants were either confident or very confident in discussing goals of care (93%) and prognosis (87%). Fewer were confident or very confident in responding to patients or families who had not accepted the seriousness of an illness (59%) or in managing conflict (50%). Other frequently cited barriers were lack of time, lack of prior discussions in the outpatient setting, unrealistic prognostic expectations from other physicians, limited institutional support, and difficulty finding records of previous discussions. Discussion: Our results suggest opportunities to improve hospitalists' ability to lead serious illness communication by increasing the time hospitalists have for discussions, improving documentation systems and communication between inpatient and outpatient clinicians, and targeted training on challenging communication scenarios.

AB - Objective: To describe the concerns, confidence, and barriers of practicing hospitalists around serious illness communication. Background: Hospitalist physicians are optimally positioned to provide primary palliative care, yet their experiences in serious illness communication are not well described. Methods: Web-based survey, conducted in May 2016. The survey link was distributed via email to 4000 members of the Society of Hospital Medicine. The 39-item survey assessed frequency of concerns about serious illness communication, confidence for common tasks, and barriers using Likert-type scales. It was developed by the authors based on prior work, a focus group, and feedback from pilot respondents. Results: We received 332 completed surveys. On most or every shift, many participants reported having concerns about a patient's or family's understanding of prognosis (53%) or the patient's code status (63%). Most participants were either confident or very confident in discussing goals of care (93%) and prognosis (87%). Fewer were confident or very confident in responding to patients or families who had not accepted the seriousness of an illness (59%) or in managing conflict (50%). Other frequently cited barriers were lack of time, lack of prior discussions in the outpatient setting, unrealistic prognostic expectations from other physicians, limited institutional support, and difficulty finding records of previous discussions. Discussion: Our results suggest opportunities to improve hospitalists' ability to lead serious illness communication by increasing the time hospitalists have for discussions, improving documentation systems and communication between inpatient and outpatient clinicians, and targeted training on challenging communication scenarios.

KW - hospitalists

KW - serious illness communication

KW - survey research

UR - http://www.scopus.com/inward/record.url?scp=85038026247&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85038026247&partnerID=8YFLogxK

U2 - 10.1089/jpm.2016.0515

DO - 10.1089/jpm.2016.0515

M3 - Review article

C2 - 28375816

AN - SCOPUS:85038026247

VL - 20

SP - 1013

EP - 1019

JO - Journal of Palliative Medicine

JF - Journal of Palliative Medicine

SN - 1096-6218

IS - 9

ER -