ArticleCJEM2025
Discussions about goals of care in the emergency department: a qualitative study of emergency physicians' opinions using the normalization process theory.
Article in CJEM, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
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Who cites it
1 citing paper in PubMed.
- Caregivers' burden of care during emergency department care transitions among older adults: a mixed methods cohort study.BMC geriatrics · 2024Observational
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Authors and funding
8 authors.
Funding
Abstract
purposeWe explored emergency department (ED) physicians' opinions about leading goals of care discussions in their daily practice. We contextualized our findings within the current landscape of ED goals of care.
methodsThis qualitative study was based on the Normalization Process Theory. We conducted semi-structured interviews with a convenience sample of ten emergency physicians from one academic ED (Lévis, Canada) and aimed to reach data saturation. Using a mixed deductive and inductive thematic analysis, we codified the interviews under the four Normalization Process Theory constructs: coherence, cognitive participation, collective action, and reflexive monitoring.
resultsWe interviewed 10 emergency physicians. Fourteen themes were identified as factors influencing the feasibility of implementing goals of care discussions in the ED: (1) interpersonal communication, (2) efficiency of care, (3) anxiety generated by the discussion, (4) meeting between clinicians, patients and family, (5) importance of goals of care during handover, (6) deterioration catalyzing the goals of care discussions, (7) lack of training, (8) availability of protocols, (9) heterogeneous prioritization of goals of care discussions, (10) take action before the ED, (11) need for education, (12) legislation, (13) adapt the ED environment, and (14) requirement to lead goals of care discussions.
conclusionGoals of care discussions are possible and essential with selected ED patients. Physicians identified outstanding needs to normalize goals of care discussions in their practice: education for both themselves and patients on the concept of goals of care discussions, legislative action for the systematization of goals of care discussions for patients, and proactive documentation of patients' preferences pre-ED. Patient, clinician and system-level policy-making efforts remain necessary to address these needs and ensure the normalization of goals of care discussions in emergency physicians' daily practice as suggested by clinical guidelines.
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Registered trials
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