Péloquin Fannie, Marmen Émile, Gélinas Véronique, Plaisance Ariane, Linteau Maude, Nolet Audrey, Germain Nathalie, Archambault Patrick M
Department of Family Medicine and Emergency Medicine, Université Laval, Québec, QC, Canada.
Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada.
CJEM. 2025 Jun 8. doi: 10.1007/s43678-025-00911-8.
We 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.
This 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.
We 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.
Goals 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.
我们探讨了急诊科（ED）医生对日常临床实践中护理目标讨论主要目标的看法。我们将研究结果置于当前急诊科护理目标的背景下。
本定性研究基于规范化过程理论。我们对来自加拿大魁北克省勒维市一家学术性急诊科的10名急诊医生进行了便利抽样的半结构化访谈，旨在达到数据饱和。采用演绎与归纳相结合的主题分析方法，我们将访谈内容按照规范化过程理论的四个构建进行编码：连贯性、认知参与、集体行动和反思性监测。
我们访谈了10名急诊医生。确定了14个主题作为影响在急诊科实施护理目标讨论可行性的因素：（1）人际沟通；（2）护理效率；（3）讨论引发的焦虑；（4）临床医生、患者和家属之间的会面；（5）交接过程中护理目标的重要性；（6）病情恶化促使护理目标讨论；（7）缺乏培训；（8）方案的可用性；（9）护理目标讨论的异质性优先级；（10）在进入急诊科之前采取行动；（11）教育需求；（12）立法；（13）适应急诊科环境；（14）主导护理目标讨论的要求。
对于部分急诊科患者而言，护理目标讨论是可行且必要的。医生们指出，在其实践中，将护理目标讨论规范化存在明显需求：对自身和患者进行护理目标讨论概念的教育、采取立法行动使患者护理目标讨论系统化，以及在患者进入急诊科之前主动记录其偏好。正如临床指南所建议的，患者、临床医生和系统层面的政策制定努力对于满足这些需求并确保急诊医生日常实践中护理目标讨论的规范化仍然是必要的。
