Uncovering psychosocial contexts in goals of care conversations : a qualitative study in a multi-centered randomized controlled trial

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GAMBINO, Julia | SCHLICHTE, Lindsay M. | HAVERFIELD, Marie C. | LIBMAN, Craig | BEKELMAN, David B. | MA, Jessica E.

OBJECTIVES: Patients often struggle with psychological and social stressors that accompany life-limiting chronic illness. Because psychosocial concerns may be conveyed through emotional sentiments, this study aimed to identify emotional expressions to describe psychosocial contexts communicated during goals of care conversations. METHODS: This qualitative study evaluated 26 transcripts of goals of care conversations using a "goals of communication guide" from the ADvancing system Alleviation with Palliative Treatment (ADAPT) trial in VA Eastern Colorado and Puget Sound Health Systems. Using an inductive and deductive approach, a codebook was developed to examine participants' expressed emotions regarding overall goals of care, illness, end of life, and family involvement. Major themes around psychosocial concerns were summarized. RESULTS: Four themes on psychosocial contexts in goals of care conversations emerged, with instances of both positive and negative affect. Participants commonly discussed contexts relating to: acceptance of illness, the feeling of being a burden; illness transitions; and suffering from disease. CONCLUSIONS: Unprompted within these conversations, patient emotional sentiments in goals of care conversations highlight psychosocial contexts important to patient values and preferences around treatment decisions. CLINICAL IMPLICATIONS: Emphasis on clinician recognition of these psychosocial contexts may help clinicians better support and elicit patient goals and preferences.

http://dx.doi.org/10.1080/07317115.2025.2464023

Voir la revue «Clinical gerontologist»

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