Background: As generalist physicians on the frontlines of hospital care for seriously ill patients across the country, hospitalists are optimally positioned to lead discussions regarding serious illness. Little is known about hospitalists’ confidence in serious illness communication, or the barriers that limit their engagement. Methods: To assess perspectives on serious illness communication, we surveyed hospitalists [...]

Background: Advance care planning is nationally recognized as important for honoring patient wishes at the end of life. Despite this widespread recognition, many patients lack advance care planning and spend their last days in ways not concordant with their values. Moreover, traditional advance directives may provide only a partial context for patients’ belief systems relevant [...]

Background: Clinicians face substantial challenges in limiting life-prolonging interventions (e.g., ICU admission, life-sustaining treatments, invasive procedures) near the end of life, even when they judge these interventions to be non-beneficial [1-3]. The objective of our study was to empirically derive a descriptive framework of decision-making approaches used by clinicians to limit (i.e., withhold or withdraw) [...]

Background: Code status discussions often link do-not-intubate (DNI) orders with do-not-resuscitate (DNR) orders, although cardiac arrest accounts for less than 2% of endotracheal intubations. DNR orders are more commonly implemented for older patients with more comorbid conditions regardless of the reason for hospitalization, and are associated with withholding treatments outside of the cardiac arrest setting. [...]

Background: Moral distress, the inability to act in accordance with one’s ethical beliefs due to hierarchical or institutional constraints, has been associated with burnout and poorer well-being.  Significant moral distress amongst American physician trainees might occur when they feel obligated to provide treatments at the end of life that they believe to be futile or [...]

Background: Patients with limited English proficiency (LEP) experience inferior health outcomes. The end-of-life period represents a particularly vulnerable time for LEP patients who may not receive optimal symptom management due to language barriers and other factors. There is limited data on disparities in provider practices around opioid administration based on patient LEP status, particularly at [...]

Background: Aggressive EOL treatments in advanced cancer patients are associated with low-value care and frequently lead to unnecessary hospitalizations. Since 2012, the National Quality Forum (NQF), American Society of Clinical Oncology (ASCO), and Centers for Medicare and Medicaid Services (CMS) have adopted EOL quality measures to reduce aggressive care. Using these measures, we conducted a [...]

Background: Advance care planning (ACP) informs future medical decision-making, particularly for hospitalized patients with older age or serious illness. The majority of end-of-life conversations are led by hospitalists in the inpatient setting. Despite the importance of ACP in end-of-life care, health disparities exist, with racial and ethnic minorities less likely to have advanced directives and [...]

Background: Problem Definition: Inadequate Advance Care Planning conversations and documentation remain a persistent gap in healthcare delivery. Admitting patients to the inpatient service without explicitly exploring the ‘goals of care’ and ‘code status’ results in stressful moments for the patients, their families, and providers if the condition deteriorates and may result in providing care that [...]

Background: Misalignment of goals of care at the End-of-Life exposes patients to risk and the health care system to considerable costs. A lack of end of life conversations can lead to unrealistic patient expectations, patient harm, and multiple hospital readmissions. This study aims to identify physician perspectives on the barriers to initiating end of life [...]