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Differences in Goals of Care Discussion Outcomes Among Healthcare Providers

By: Karen Ho, Krystyna Wang, Adam Clay, & Elizabeth Gibbings

Objectives and Introduction: Goals of care (GOC) discussions allow clinicians to provide the best possible care and ensure patients receive the care that they want. Recent studies have recognized the opportunity for an expanded role for allied health professionals in facilitating GOC discussions. The objective of this study is to compare the outcomes of GOC discussions completed by physicians and nurses.

Methods: A retrospective chart review of 200 patients admitted to the Internal Medicine service at Regina General Hospital was completed. The outcomes of GOC discussions led by physicians and nurses were compared using Pearson’s Chi-squared or Fisher Exact tests. Multiple logistic regression was used to identify the relationship between individual variables and patients’ GOC decisions.

Results: Of the 200 patients reviewed, 52% of the GOC discussions were completed by nurses and 48% by medical students, residents, or physicians. There was no significant difference in gender, age, comorbidities, or illness severity between the two cohorts. There was a significant association between the healthcare provider leading the GOC discussions and the discussion outcomes p= 0.003), with patients more likely to accept cardiopulmonary resuscitation (CPR) in nurse-led discussions (80.8%) compared to physician-led ones (61.4%). The difference was particularly pronounced in patients with high comorbidity (p=0.01) and illness severity (p=0.009) (NEWS2) scores. Multiple regression showed that patients with higher CCI (OR 0.71, 95% CI: 0.62-0.82, p<0.001), higher NEWS2 (OR 0.89, 95% CI 0.88-0.99, p=0.03), and physician-led GOC discussions (OR 0.30, 95% CI: 0.15-0.62, p<0.001) were less likely to accept CPR.

Conclusions: There was a significant difference between the outcomes of GOC discussions led by nurses and physicians. Patients are more likely to accept aggressive resuscitative measures in nurse-led GOC discussions. Further research efforts are needed to identify the factors contributing to this discrepancy, and to devise ways of improving GOC discussion delivery.

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