Co‐Designing Solutions to Improve Communication About Serious Illness During Hospitalisation
Notice bibliographique
Résumé
BACKGROUND: Serious illness conversations (SICs) that explore patient priorities are becoming increasingly important to high-quality care for those with life-limiting conditions admitted to general internal medicine wards. While patient-cited barriers to SIC include a lack of understanding of complex medical terminology, expected illness course and life-sustaining interventions, providers cite poor documentation and lack of training and support. For seriously ill patients to receive care that aligns with their values and goals, interventions that address these barriers need to be designed in consultation with patients and their providers and tailored to the context of their medical setting and broader health system. METHODS: We report on the last phase of an overarching quality improvement project aimed at increasing documentation of SIC and improving patient/caregiver and provider experiences during SIC through co-design. This phase was conducted on the general internal medicine wards at an academic teaching hospital network in Canada. Twenty-five providers spanning various disciplines and departments participated in three co-design workshops with 13 patients and caregivers between September and December 2023. Facilitated by experts in human-centred design, the workshops sought to build on existing evidence and experience with known interventions to co-produce solutions to SIC challenges. Patient, caregiver and provider priorities were established along with a set of design principles, guiding participants through solution ideation and refinement. RESULTS: The collaboratively developed design principles (clear, compassionate, informed and reciprocal) guided the co-production of solutions to improve in-hospital SICs. Workshop attendees designed solutions that built on revising existing conversation guides, harnessing electronic medical record infrastructure to create collaborative advanced care planning notes, and supporting the role of a facilitator that could offer more structured and routine SIC during hospitalisation. CONCLUSIONS: Increasing knowledge of and access to SIC resources, such as patient conversation guides, advance care planning notes and establishment of Goals of Care Facilitators, were found in co-design to be key solutions to address long-standing barriers to engaging in high-quality SIC and contribute to improving patient and provider experience and outcomes. PATIENT OR PUBLIC CONTRIBUTION: Patients and caregivers with lived experience were directly involved in the design sessions outlined in our study, setting priorities and developing solutions alongside healthcare providers and research staff.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,007 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».