The differences in code status conversation approaches reported by emergency medicine and palliative care clinicians:...

Area of Science:

• Medical Ethics
• Palliative Care
• Emergency Medicine

Background:

• Code status discussions are routine for seriously ill patients during acute health deterioration.
• Approaches used by emergency medicine and palliative care clinicians in these conversations are not well understood.
• This study aimed to explore differences in how these clinicians conduct code status conversations.

Purpose of the Study:

• To elucidate the methods emergency medicine and palliative care clinicians use in code status conversations.
• To understand the reasons behind any differences in their approaches.
• To compare value-based versus procedure-based questioning strategies.

Main Methods:

• A sequential-explanatory, mixed-method study was conducted across three academic medical centers.
• Clinicians completed surveys assessing their likelihood of using value-based and procedure-based questions.
• Semistructured interviews were conducted with a subset of survey respondents for in-depth rationale exploration.

Main Results:

• A significant difference in approaches was observed: 91% of palliative care clinicians asked about quality of life versus 59% of emergency medicine clinicians.
• Palliative care clinicians emphasized value-based questions for understanding patient goals.
• Emergency medicine clinicians found value-based questions vague and time-consuming in emergency settings.

Conclusions:

• Emergency medicine and palliative care clinicians employ distinct strategies for code status conversations.
• These differing rationales are likely influenced by their respective clinical environments and experiences.