Talk to me: seriously ill patients’ views on physician behaviours that influence the quality of end-of-life communication

Talk to Me was a study where patients at four hospitals in Ontario and Alberta were surveyed and interviewed to better understand the communication needs of patients engaged in advance care planning (ACP) with their physicians.

Research Results

Findings: Most physicians did not discuss advance care planning with patients, despite the patients’ desire to have these discussions. Readiness for advance care planning was a mediating factor. The content of the advance care planning discussion needs to be tailored to the patients’ willingness and readiness to discuss their advance care plan. The findings will provide key information to be included in advance care planning skill-building seminars and workshops for physicians, and will help to design other strategies to improve the quality of ACP in Canada.

Impact of findings: This study can impact the quality of care patients receive at the end of life. Physicians need to assess the patients’ readiness to discuss advance care planning. The discussion around advance care planning should be patient-centered and tailored to their readiness to discuss their advance care plan. These findings can inform policy around advance care planning during end of life care in the hospital. Healthcare providers will be more informed about their patients’ preferences for communication around advance care planning and be better equipped to care for patients as they consider their wishes for care at the end of life.

Publications, presentations and webinars

For more information on why this research matters, click the links below:

Policy        Families        Researchers

About the Project

Recent work at Canadian hospitals has found there is often poor quality of communication between seriously ill patients and their physicians about ACP.

Ultimately this study will improve the care of the seriously ill. Health care providers will now be more informed about their patients’ preferences for communication around ACP and be better equipped to care for patients as they consider their wishes for care at the end-of-life.

For more details on the project rationale and objectives/research plan, click here.

Project Team

Principal Investigators:

John You, MD, MSc, FRCPC — McMaster University

Jessica Simon, MBChB, FRCPC — University of Calgary

Co-Investigators:

Amane Abdul-Razzak, MD — McMaster University/University of Calgary

Kevin Brazil, PhD — Queen’s University Belfast

Diana Sherifali, PhD, BScN — McMaster University

Project Contact: Dr. John You — jyou@mcmaster.ca

CORE 2012-03

Key Findings For Families

Talk to Me was a study where patients at four hospitals in Ontario and Alberta were surveyed and interviewed to better understand the communication needs of patients engaged in advance care planning (ACP) with their physicians.

Project Contact: Dr. John You — jyou@mcmaster.ca

Key Findings for Families

The results of this study can help doctors know what to talk about, and when to talk about it with older patients at the end-of-life (EOL).

  • Most physicians don’t talk about what medical treatments patients want as they get sicker at the end of their life, despite many patients wanting to talk about it
  • Not all patients want to talk about the same things
  • Talking about medical care at the EOL needs to be done in a different way for each person

Why This Matters

Discussing what medical treatments patients want as they get sicker (ACP) can improve the care people get at this important time. Talking about these things is not done well in Canadian hospitals. The reason why talking about medical care at the EOL is not as good as it can be, is not known.

About This Study

  • The reason this study was done was to understand how and when physicians should talk to patients about what medical care they want as they get sicker at the EOL
  • This study used two types of methods (one used numbers [quantitative] and one used words [qualitative]) to really understand what patients want 
  • The patients in the study were seriously ill older patients in hospital
  • The study included 132 patients and took place in four hospitals in two provinces

Back to CORE 2012-03 Project Page

Policy

Talk to Me was a study where patients at four hospitals in Ontario and Alberta were surveyed and interviewed to better understand the communication needs of patients engaged in advance care planning (ACP) with their physicians.

Project Contact: Dr. John You — jyou@mcmaster.ca

Key Findings for Policy

These findings can inform policy around ACP during end-of-life (EOL) care in hospital.

  • Most physicians did not discuss ACP with patients, despite the patients’ desire to have these discussions
  • The patients’ readiness for ACP was an important factor
  • The content of the discussion needs to be tailored to the patients’ willingness and readiness to discuss ACP

Why This Study was Needed

ACP (discussing what medical treatment the patient wants as they get sicker) can reduce health care cost at the EOL and improve the quality of care during this crucial time. However, effective ACP is poorly done in Canadian hospitals. The reasons for ineffective ACP in critically ill elderly patients are unknown.

Study Summary

  • The study’s objective was to determine the needs of patients around ACP at the EOL
  • This was a mixed-methods study – a survey and interviews
  • The patients that participated in the study were seriously ill elderly patients, in hospital
  • The study included 132 patients and took place in four hospitals in Alberta and Ontario

Back to CORE 2012-03 Project Page

Researchers

Talk to Me was a study where patients at four hospitals in Ontario and Alberta were surveyed and interviewed to better understand the communication needs of patients engaged in advance care planning (ACP) with their physicians.

Project Contact: Dr. John You — jyou@mcmaster.ca

Key Findings for Researchers

This study can impact the quality of care patients receive at the end-of-life (EOL).

  • Most physicians did not discuss ACP with patients, despite the patients’ desire to have these discussions
  • Readiness for ACP was a mediating factor
  • The content of the ACP discussion needs to be tailored to the patients’ willingness and readiness to discuss

Why This Study was Needed

ACP can reduce both health care cost at the EOL and improve the quality of care during this crucial time. However, effective ACP is poorly done in Canadian hospitals. The reasons for ineffective ACP in critically ill elderly patients are unknown.

How This Study Addresses the Gap

This study asked seriously ill elderly patients, admitted to hospital, about what they wanted their physicians to communicate with them at the EOL. The study included 132 patients and took place in four hospitals in Alberta and Ontario. This mixed-methods study used surveys and interviews to determine the important aspects of ACP from the patient’s perspective. The use of both quantitative and qualitative methods is important to fully understand this complex issue.

Future Research

Reliable and valid tools for physicians to determine readiness for ACP are needed.

Back to CORE 2012-03 Project Page

Publications

Talk to Me was a study where patients at four hospitals in Ontario and Alberta were surveyed and interviewed to better understand the communication needs of patients engaged in advance care planning (ACP) with their physicians.

Principal Investigators

John You, MD, MSc, FRCPC — McMaster University

Jessica Simon, MBChB, FRCPC — University of Calgary

Publications

Abdul-Razzak, A., You, J., Sherifali, D., Simon, J., Brazil, K. (2014). “Conditional candour” and “knowing me:” an interpretive description study on patient preferences for physician behaviours during end-of-life communication. BMJ Open 4:e005653. BMJ group. Doi:10.1136//bmjopen-2014-005653.

Abdul-Razzak, A. (2013). “Talk to me:” a mixed methods study on seriously ill patients’ views on physician behaviours during advance care planning and end-of-life communication. Masters Thesis, McMaster University, Canada. 183p.

Presentations

Abdul-Razzak, A., You, J., Sherifali, D., Simon, J., Brazil, K. (September, 2014). Patient Preferences for Physician’s End-of-Life Communication Behaviours. J Palliat Care 30(3) Abstr.F12-B. Presented at 20th International Congress on Palliative Care. Montréal, QC.

Webinars

Talk to me: seriously ill patients’ views on physician behaviours that influence the quality of end-of-life communication — John You

Back to CORE 2012-03 Project Page

Rationale

Talk to Me was a study where patients at four hospitals in Ontario and Alberta were surveyed and interviewed to better understand the communication needs of patients engaged in advance care planning (ACP) with their physicians.

Principal Investigators

John You, MD, MSc, FRCPC — McMaster University

Jessica Simon, MBChB, FRCPC — University of Calgary

Rationale: Advance care planning can reduce health care cost at the end-of-life and improve the quality of care during this crucial time. However, effective advance care planning is poorly done in Canadian hospitals. The reasons for ineffective advance care planning in critically ill elderly patients are unknown. The results from this study will inform ongoing efforts across Canada to improve doctors’ advance care planning skills.

Objectives/Research Plan: This study asked seriously ill elderly patients, admitted to hospital about what they wanted their physicians to communicate with them at the end of life. The study included 132 patients, and took place in four hospitals in Alberta and Ontario. This mixed-methods study used surveys and interviews to determine the important aspects of advance care planning from the patient’s perspective. The use of both quantitative and qualitative methods is important to fully understand this complex issue.

Back to CORE 2012-03 Project Page