Show simple item record Mohan, D Alexander, SC Garrigues, SK Arnold, RM Barnato, AE
dc.coverage.spatial United States 2011-04-15T16:46:31Z 2010-08
dc.identifier.citation J Palliat Med, 2010, 13 (8), pp. 949 - 956
dc.description.abstract BACKGROUND: Shared decision-making has become the standard of care for most medical treatments. However, little is known about physician communication practices in the decision making for unstable critically ill patients with known end-stage disease. OBJECTIVE: To describe communication practices of physicians making treatment decisions for unstable critically ill patients with end-stage cancer, using the framework of shared decision-making. DESIGN: Analysis of audiotaped encounters between physicians and a standardized patient, in a high-fidelity simulation scenario, to identify best practice communication behaviors. The simulation depicted a 78-year-old man with metastatic gastric cancer, life-threatening hypoxia, and stable preferences to avoid intensive care unit (ICU) admission and intubation. Blinded coders assessed the encounters for verbal communication behaviors associated with handling emotions and discussion of end-of-life goals. We calculated a score for skill at handling emotions (0-6) and at discussing end of life goals (0-16). SUBJECTS: Twenty-seven hospital-based physicians. RESULTS: Independent variables included physician demographics and communication behaviors. We used treatment decisions (ICU admission and initiation of palliation) as a proxy for accurate identification of patient preferences. Eight physicians admitted the patient to the ICU, and 16 initiated palliation. Physicians varied, but on average demonstrated low skill at handling emotions (mean, 0.7) and moderate skill at discussing end-of-life goals (mean, 7.4). We found that skill at discussing end-of-life goals was associated with initiation of palliation (p = 0.04). CONCLUSIONS: It is possible to analyze the decision making of physicians managing unstable critically ill patients with end-stage cancer using the framework of shared decision-making.
dc.format.extent 949 - 956
dc.language eng
dc.language.iso en_US en_US
dc.relation.ispartof J Palliat Med
dc.relation.isversionof 10.1089/jpm.2010.0053
dc.subject Adult
dc.subject Advance Care Planning
dc.subject Attitude of Health Personnel
dc.subject Clinical Competence
dc.subject Communication
dc.subject Cooperative Behavior
dc.subject Critical Illness
dc.subject Decision Making
dc.subject Female
dc.subject Humans
dc.subject Male
dc.subject Medical Staff, Hospital
dc.subject Neoplasms
dc.subject Patient Participation
dc.subject Pennsylvania
dc.subject Physician-Patient Relations
dc.subject Pilot Projects
dc.subject Practice Patterns, Physicians'
dc.subject Single-Blind Method
dc.subject Statistics, Nonparametric
dc.subject Tape Recording
dc.subject Terminal Care
dc.title Communication practices in physician decision-making for an unstable critically ill patient with end-stage cancer.
dc.type Journal Article
dc.description.version Version of Record en_US 2010-8-0 en_US
duke.description.endpage 956 en_US
duke.description.issue 8 en_US
duke.description.startpage 949 en_US
duke.description.volume 13 en_US
dc.relation.journal Journal of palliative medicine en_US
pubs.issue 8
pubs.organisational-group /Duke
pubs.organisational-group /Duke/School of Medicine
pubs.organisational-group /Duke/School of Medicine/Clinical Science Departments
pubs.organisational-group /Duke/School of Medicine/Clinical Science Departments/Medicine
pubs.organisational-group /Duke/School of Medicine/Clinical Science Departments/Medicine/Medicine, General Internal Medicine
pubs.organisational-group /Duke/School of Nursing
pubs.organisational-group /Duke/School of Nursing/School of Nursing - Secondary Group
pubs.publication-status Published
pubs.volume 13
dc.identifier.eissn 1557-7740

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