Barriers and facilitators for goals of care discussions between residents and hospitalised patients
Abstract
PURPOSE: To observe how residents are engaging in goals of care discussions with patients and identify thematic patterns that inhibited (barriers) and promoted discussion (facilitators) about goals of care. DESIGN: Admission encounters between residents and patients admitted to a tertiary care academic hospital were recorded and analysed using a qualitative descriptive method. Patients included in the study were individuals over the age of 65 being admitted to the internal medicine service. Residents were eligible if they were trainees in family medicine, emergency medicine, general surgery or internal medicine who were on call for the inpatient medicine rotation. RESULTS: A total of 15 resident-patient encounters were recorded and analysed, of which 12 encounters included a goals of care discussion. Barriers to goals of care discussions were due to missed opportunities to clarify patient's preferences for life-sustaining treatment and missed opportunities to engage the patient in further discussion. Facilitators to goals of care discussions were use of simple language and exploration of patient's previous experiences with life-sustaining treatment. CONCLUSIONS: Asking about patients' previous experiences with life support can be an effective strategy to gauge the patient's understanding and goals of care preferences. This knowledge can improve residents' skill in communicating with their patients about goals of care and inform future education initiatives.
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Timely and high-quality assessment of patients' goals of care remains a significant shortcoming in health systems.
“However, timely and high-quality assessment of patients’ goals of care remains a significant shortcoming in health systems.9–11”
From Assessment of a Zero-Shot Large Language Model in Measuring Documented Goals-of-Care Discussions (2026) · cites this paper as [10]
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Assessment of a Zero-Shot Large Language Model in Measuring Documented Goals-of-Care Discussions
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- Authors
- Shah, K., Swinton, M., & You, J. J.
- Affiliations
- University of Toronto (CA)
- McMaster University (CA)
- Corresponding author
- You, John J
- ORCID
- You, John J
- Venue
- Postgraduate Medical Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2016-07-22
- Volume
- 93
- Issue
- 1097
- Pages
- 127-132
- ISSN
- 0032-5473 (ISSN-L)
- 1469-0756
- OpenAlex
- W2495024261
- Cited by
- 24
- References
- 9
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 2 · 2023: 6 · 2022: 4 · 2021: 5 · 2020: 1 · 2019: 2
- FWCI
- 0.66
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Postgraduate Medical Journal (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Keywords
- goals of care discussions, barriers and facilitators, life-sustaining treatment preferences, hospitalized older adults, internal medicine residents, communication skills, patient engagement, advance care planning, physician training
- MeSH terms
- Aged, Female, Humans, Inpatients, Internal Medicine, Internship and Residency, Male, Medical Staff, Hospital, Patient Care Planning, Physician-Patient Relations
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