TY - JOUR
T1 - “I was not able to keep myself away from tending to her immediate needs”
T2 - Primary Care Physicians’ Perspectives of Serious Illness Conversations at Community Health Centers
AU - Swiderski, Deborah
AU - Georgia, Annette
AU - Chuang, Elizabeth
AU - Stark, Allison
AU - Sanders, Justin
AU - Flattau, Anna
N1 - Publisher Copyright:
© 2021, Society of General Internal Medicine.
PY - 2022/1
Y1 - 2022/1
N2 - Purpose: Seriously ill patients in low-income and minority populations have lower rates of advance care planning. Initiatives that promote serious illness (SI) conversations in community health centers (CHCs) can reach broad, diverse patient populations. This qualitative study explored the experiences of primary care physicians in conducting SI conversations at CHCs in order to understand challenges and needs in this setting. Methods: An initiative to increase SI conversations was implemented at two CHCs in the Bronx, NY. Eleven participating family physicians who together conducted 37 SI conversations underwent semi-structured in-depth interviews. The 11 interviews were analyzed using inductive thematic analysis. Results: Eight themes emerged: (1) Structured approaches to SI conversations are useful even in longstanding patient-doctor relationships; (2) Discussion of prognosis is meaningful but difficult; (3) Emotional work is humanizing but draining; (4) Poverty and underinsurance are high priorities; (5) Social context affects patient readiness; (6) Communication barriers take multiple forms; (7) Patient characteristics make it “easier” or “harder” to initiate the SI conversation; (8) Time constraints limit the ability to meet multiple patient needs. Conclusions: Physicians at CHCs identified challenges in SI conversations at personal, interpersonal, organizational, and societal levels. These challenges should be addressed by initiatives that aim to increase SI conversations in primary care, and especially at CHCs.
AB - Purpose: Seriously ill patients in low-income and minority populations have lower rates of advance care planning. Initiatives that promote serious illness (SI) conversations in community health centers (CHCs) can reach broad, diverse patient populations. This qualitative study explored the experiences of primary care physicians in conducting SI conversations at CHCs in order to understand challenges and needs in this setting. Methods: An initiative to increase SI conversations was implemented at two CHCs in the Bronx, NY. Eleven participating family physicians who together conducted 37 SI conversations underwent semi-structured in-depth interviews. The 11 interviews were analyzed using inductive thematic analysis. Results: Eight themes emerged: (1) Structured approaches to SI conversations are useful even in longstanding patient-doctor relationships; (2) Discussion of prognosis is meaningful but difficult; (3) Emotional work is humanizing but draining; (4) Poverty and underinsurance are high priorities; (5) Social context affects patient readiness; (6) Communication barriers take multiple forms; (7) Patient characteristics make it “easier” or “harder” to initiate the SI conversation; (8) Time constraints limit the ability to meet multiple patient needs. Conclusions: Physicians at CHCs identified challenges in SI conversations at personal, interpersonal, organizational, and societal levels. These challenges should be addressed by initiatives that aim to increase SI conversations in primary care, and especially at CHCs.
KW - advance care planning
KW - community health centers
KW - health communication
KW - primary care
KW - qualitative research
UR - http://www.scopus.com/inward/record.url?scp=85111579610&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85111579610&partnerID=8YFLogxK
U2 - 10.1007/s11606-021-06921-3
DO - 10.1007/s11606-021-06921-3
M3 - Article
C2 - 34327652
AN - SCOPUS:85111579610
SN - 0884-8734
VL - 37
SP - 130
EP - 136
JO - Journal of general internal medicine
JF - Journal of general internal medicine
IS - 1
ER -