Original Research

Nurse Communication About Goals of Care

Elaine Wittenberg(1) PhD, Betty Ferrell,(1) RN, PhD, MA, FAAN, FPCN, CHPN, Joy Goldsmith,(2) PhD, Haley Buller,(3) MS, and Tammy Neiman,(4) MS, RN-BC

From 1City of Hope National Medical Center, Division of Nursing Research and Education, Duarte, California, 2University of Memphis, Tennessee, 3Chapman University, Orange, California, 4St. Catherine University, St. Paul, Minnesota

Elaine Wittenberg, PhD, City of Hope National Medical Center, Division of Nursing Research and Education, 1500 E. Duarte Road, Pop Sci Bldg 173, Duarte, CA 91010.
E-mail: ewittenberg@coh.org

Authors’ disclosures of potential conflicts of interest are found at the end of this article.


J Adv Pract Oncol 2016;7:146–154 | doi: 10.6004/jadpro.2016.7.2.2 | © 2016 Harborside Press®


  

ABSTRACT

Abstract

Conversations about goals of care with the patient and family are a critical component of advanced practice in oncology. However, there are often inadequate team structures, training, or resources available to assist advanced practitioners in initiating these conversations. We conducted a study to assess nurses’ perceived role and communication tasks in such conversations about goals of care. In a cross-sectional survey of 109 nurses attending a comprehensive 2-day end-of-life nursing education course, nurses were asked to describe how they would participate in a “goals of care” meeting in three different scenarios. They were also asked what changes they desired in their clinical settings. Nurses overwhelmingly described that their primary task and communication role was to assess patient/family understanding. Nurses referenced their team members and team support with the least frequency across scenarios. Team roles, structure, and process were reported as areas in greatest need of change in patient/family goals of care meetings. These findings demonstrate that lack of preparation to function as a team is a barrier for nurses in communicating about goals of care, and there is a demand to move such conversations upstream in oncology care.




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