Grant: Operating Grant

With an aging population increasingly exposed to the unwanted use of technology at the end of life, improving communication and decision-making about goals of care is the single most important action we can take to provide high quality, patient-centered care near the end of life. The unwanted use of technology at the end of life is associated with poorer quality of life, lower satisfaction with care, and increased anxiety and depression among family members. Moreover, the use of intensive technology at the end of life incurs enormous costs, placing increased strain on finite healthcare resources. Improved communication and decision-making about goals of care (defined as the use of life sustaining technologies such as CPR, breathing machines, dialysis, and intensive care unit admission) near the end of life offers a potential win-win solution, improving quality of care while at the same time making the most efficient use of limited health care resources. Our prior work has found that end of life communication and decision-making are important to hospitalized patients in Canada and their families, but they are not satisfied with current practice. The DECIDE study will take place at 12 hospitals across Canada to identify barriers and potential innovative solutions to improve communication and decision-making about goals of care, focusing upon the perspectives of physicians and nurses. In a companion, CIHR-funded study entitled ACCEPT, we will identify barriers to this process from the perspectives of hospitalized patients and their families. The results of these studies will be of value to institutions, clinical care teams, and individual physicians interested in improving the quality of end of life care, and will allow us to design and test strategies to improve communication and decision-making regarding goals of care between seriously ill hospitalized patients and their healthcare providers.