Managing Bias in Palliative Care: Professional Hazards in Goals of Care Discussions at the End of Life.
Am J Hosp Palliat Care
; 35(2): 355-363, 2018 Feb.
Article
en En
| MEDLINE
| ID: mdl-28486834
BACKGROUND: In the setting of end-of-life care, biases can interfere with patient articulation of goals and hinder provision of patient-centered care. No studies have addressed clinician bias or bias management specific to goals of care discussions at the end of life. OBJECTIVES: To identify and determine the prevalence of palliative care clinician biases and bias management strategies in end-of-life goals of care discussions. DESIGN: A semistructured interview guide with relevant domains was developed to facilitate data collection. Participants were asked directly to identify biases and bias management strategies applicable to this setting. Two researchers developed a codebook to identify themes using a 25% transcript sample through an iterative process based on grounded theory. Inter-rater reliability was evaluated using Cohen κ. It was 0.83, indicating near perfect agreement between coders. The data approach saturation. SETTING/PARTICIPANTS: A purposive sampling of 20 palliative care clinicians in Middle Tennessee participated in interviews. RESULTS: The 20 clinicians interviewed identified 16 biases and 11 bias management strategies. The most frequently mentioned bias was a bias against aggressive treatment (n = 9), described as a clinician's assumption that most interventions at the end of life are not beneficial. The most frequently mentioned bias management strategy was self-recognition of bias (n = 17), described as acknowledging that bias is present. CONCLUSION: This is the first study identifying palliative care clinicians' biases and bias management strategies in end-of-life goals of care discussions.
Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Prejuicio
/
Cuidado Terminal
/
Actitud del Personal de Salud
/
Atención Dirigida al Paciente
Tipo de estudio:
Prognostic_studies
/
Qualitative_research
/
Risk_factors_studies
Límite:
Adult
/
Female
/
Humans
/
Male
/
Middle aged
País/Región como asunto:
America do norte
Idioma:
En
Revista:
Am J Hosp Palliat Care
Asunto de la revista:
ENFERMAGEM
Año:
2018
Tipo del documento:
Article
País de afiliación:
Estados Unidos
Pais de publicación:
Estados Unidos