Cultures of Practice: Specialty-Specific Differences in End-of-Life Conversations.

Area of Science:

• Medical Communication
• End-of-Life Care
• Physician Practice Patterns

Background:

• Goals of care discussions affirm patient autonomy and humanity at the end of life.
• Established best practices exist for these conversations, but specialty-specific communication differences remain under-researched.

Purpose of the Study:

• To describe and compare communication practices of internal medicine, emergency medicine, and critical care physicians.
• To analyze these differences in a high-fidelity simulation involving a terminally ill patient with defined end-of-life preferences.

Main Methods:

• Mixed-methods secondary analysis of transcripts from a multicenter study simulating end-of-life decision-making.
• 88 physicians (27 IM, 22 EM, 39 CC) evaluated a standardized patient with comfort-oriented goals.
• Discussions were sentence-coded for semantic content and analyzed by physician specialty.

Main Results:

• No significant differences were observed between specialties in intubation rates or ICU admissions.
• Significant differences emerged in the occurrence of codes for 'comfort as a goal of care,' 'noncurative goals of care,' and 'oblique references to death.'

Conclusions:

• Demonstrable differences exist in physician specialty practice patterns during end-of-life decision-making.
• While setting may contribute to variation, findings suggest training in goals of care conversations should be adapted to the distinct needs and culture of each specialty.