Serious Illness Conversations in Interhospital Transfer: Caregiver Perspectives

Introduction: Interhospital transfer (IHT) can be lifesaving but is associated with longer length of stay, higher costs, and increased inpatient mortality. Little is known about communication and decision-making processes surrounding IHT. Methods: We conducted semi-structured interviews with the surrogate decision-makers of 32 patients who died after IHT, examining perspectives on end-of-life preparations and their impact on the transfer decision-making process and surrogate coping. Results: Several themes emerged surrounding the role of end-of-life planning in IHT: (1) although end-of-life (EOL) planning practices were heterogeneous, respondents reported limited direct insight into transfer preferences; (2) surrogates extrapolated from information about other EOL care preferences to guide transfer decision-making; and (3) serious illness communication and advance care planning (ACP) played a role in surrogate coping. Conclusion: IHT is often not treated as a preference-sensitive decision; however, there is likely a role for improvements in ACP conversations to guide patients and families through goal-concordant transfer decision-making.