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Barriers and facilitators for goals of care discussions between residents and hospitalised patients
  1. Kalpa Shah1,2,
  2. Marilyn Swinton3,
  3. John J You1,3
  1. 1Department of Medicine, McMaster University, Hamilton, Ontario, Canada
  2. 2Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  3. 3Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
  1. Correspondence to Dr John You, Departments of Medicine, and Clinical Epidemiology and Biostatistics, McMaster University Medical Centre, 1280 Main Street West, Room HSC-2C8, Hamilton, Ontario, Canada L8S 4K1; jyou{at}


Purpose To observe how residents are engaging in goals of care discussions with patients and identify thematic patterns that inhibited (barriers) and promoted discussion (facilitators) about goals of care.

Design Admission encounters between residents and patients admitted to a tertiary care academic hospital were recorded and analysed using a qualitative descriptive method. Patients included in the study were individuals over the age of 65 being admitted to the internal medicine service. Residents were eligible if they were trainees in family medicine, emergency medicine, general surgery or internal medicine who were on call for the inpatient medicine rotation.

Results A total of 15 resident–patient encounters were recorded and analysed, of which 12 encounters included a goals of care discussion. Barriers to goals of care discussions were due to missed opportunities to clarify patient's preferences for life-sustaining treatment and missed opportunities to engage the patient in further discussion. Facilitators to goals of care discussions were use of simple language and exploration of patient's previous experiences with life-sustaining treatment.

Conclusions Asking about patients' previous experiences with life support can be an effective strategy to gauge the patient's understanding and goals of care preferences. This knowledge can improve residents' skill in communicating with their patients about goals of care and inform future education initiatives.

  • Goals of care, resident, communication, death
  • resuscitation
  • code status

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  • Contributors All three authors (KS, MS and JJY) made substantial contributions to the design of the study, analysis and interpretation of data for the work. Each author revised the work critically for important intellectual content and approved the final version of the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Hamilton Integrated Research Ethics Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.