Comparing approaches to code status conversations between Thai and American emergency clinicians: a survey study

Area of Science:

• Medical Communication
• Cross-Cultural Healthcare Research
• Palliative Care

Background:

• Emergency clinicians engage in critical code status conversations for shared decision-making in life-limiting illnesses.
• Sociocultural norms and healthcare systems significantly influence communication during these sensitive discussions.

Purpose of the Study:

• To investigate and compare the approaches of American and Thai emergency clinicians in conducting code status conversations.
• To identify potential cultural variations in how clinicians discuss life-sustaining treatments.

Main Methods:

• A cross-sectional survey was administered to emergency clinicians in US and Thai hospitals (December 2021-November 2022).
• The survey utilized a 5-point Likert scale to assess procedure-based and value-based components of code status conversations.
• Logistic regression analysis compared communication practices between American and Thai clinicians, controlling for confounding variables.

Main Results:

• Over 50% of clinicians frequently incorporated procedure-based components but rarely value-based components in conversations.
• American clinicians were more likely to discuss restarting the heart but less likely to inquire about vasopressor preferences or provide recommendations compared to Thai clinicians.
• Thai clinicians were more likely to assess baseline activity and provide recommendations than American clinicians.

Conclusions:

• Both American and Thai emergency clinicians prioritize discussing procedures over personal values in code status conversations.
• Distinct differences in communication strategies between the two groups suggest varying cultural underpinnings in end-of-life decision-making.
• Further research is needed to understand and address these cultural nuances for improved patient-centered care.