ArticleBMJ open2022
Caring in the silences: why physicians and surgeons do not discuss emergency care and treatment planning with their patients - an analysis of hospital-based ethnographic case studies in England.
Article in BMJ open, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed.
- Article
- Shared decision-making with older people on TReatment Escalation planning for Acute deterioration in the emergency Medical Setting - Observed (STREAMS-O): an ethnographic study.BMC geriatrics · 2025Article
- A Scoping Review on Goals of Care Discussions in Surgery: How Are We Doing and How Can We Do Better?World journal of surgery · 2025Article
- Using the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) in a community setting: does it facilitate best interests decision-making?Journal of medical ethics · 2025Article
- Public attitudes to emergency care treatment plans: a population survey of Great Britain.BMJ open · 2024Article
- Article
- Patient and relative experiences of the ReSPECT process in the community: an interview-based study.BMC primary care · 2024Article
- Perspectives of healthcare professionals and older patients on shared decision-making for treatment escalation planning in the acute hospital setting: a systematic review and qualitative thematic synthesis.EClinicalMedicine · 2023Article
- Why are some ReSPECT conversations left incomplete? A qualitative case study analysis.Resuscitation plus · 2022Article
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDespite increasing emphasis on integrating emergency care and treatment planning (ECTP) into routine medical practice, clinicians continue to delay or avoid ECTP conversations with patients. However, little is known about the clinical logics underlying barriers to ECTP conversations.
objectiveThis study aims to develop an ethnographic account of how and why clinicians defer and avoid ECTP conversations, and how they rationalise these decisions as they happen.
designA multisited ethnographic study.
settingMedical, orthopaedic and surgical wards in hospitals within four acute National Health Service trusts in England.
participantsThirty-four doctors were formally observed and 32 formally interviewed. Following an ethnographic case study approach, six cases were selected for in-depth analysis. ANALYSIS: Fieldnote data were triangulated with interview data, to develop a 'thick description' of each case. Using a conceptual framework of care, the analysis highlighted the clinical logics underlying these cases.
resultsThe deferral or avoidance of ECTP conversations was driven by concerns over caring well, with clinicians attempting to optimise both medical and bedside practice. Conducting an ECTP conversation carefully meant attending to patients' and relatives' emotions and committing sufficient time for an in-depth discussion. However, conversation plans were often disrupted by issues related to timing and time constraints, leading doctors to defer these conversations, sometimes indefinitely. Additionally, whereas surgeons and geriatricians deferred conversations because they did not have the time to offer detailed discussions, emergency and acute medicine clinicians deferred conversations because the high-turnover ward environment, combined with patients' acute conditions, meant triaging conversations to those most in need.
conclusionOvercoming barriers to ECTP conversations is not simply a matter of enhancing training or hospital policies, but of promoting good conversational practices that take into account the affordances of hospital time and space, as well as clinicians' understandings of caring well.
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