"I was not able to keep myself away from tending to her immediate needs": Primary Care Physicians' Perspectives of Serious Illness Conversations at Community Health Centers.

Authors

• Deborah Swiderski
• Annette Georgia
• Elizabeth Chuang
• Allison Stark
• Justin Sanders
• Anna Flattau

Publication/Presentation Date

1-1-2022

Abstract

PURPOSE: Seriously ill patients in low-income and minority populations have lower rates of advance care planning. Initiatives that promote serious illness (SI) conversations in community health centers (CHCs) can reach broad, diverse patient populations. This qualitative study explored the experiences of primary care physicians in conducting SI conversations at CHCs in order to understand challenges and needs in this setting.

METHODS: An initiative to increase SI conversations was implemented at two CHCs in the Bronx, NY. Eleven participating family physicians who together conducted 37 SI conversations underwent semi-structured in-depth interviews. The 11 interviews were analyzed using inductive thematic analysis.

RESULTS: Eight themes emerged: (1) Structured approaches to SI conversations are useful even in longstanding patient-doctor relationships; (2) Discussion of prognosis is meaningful but difficult; (3) Emotional work is humanizing but draining; (4) Poverty and underinsurance are high priorities; (5) Social context affects patient readiness; (6) Communication barriers take multiple forms; (7) Patient characteristics make it "easier" or "harder" to initiate the SI conversation; (8) Time constraints limit the ability to meet multiple patient needs.

CONCLUSIONS: Physicians at CHCs identified challenges in SI conversations at personal, interpersonal, organizational, and societal levels. These challenges should be addressed by initiatives that aim to increase SI conversations in primary care, and especially at CHCs.

Volume

37

Issue

1

First Page

130

Last Page

136

ISSN

1525-1497

Published In/Presented At

Swiderski, D., Georgia, A., Chuang, E., Stark, A., Sanders, J., & Flattau, A. (2022). "I was not able to keep myself away from tending to her immediate needs": Primary Care Physicians' Perspectives of Serious Illness Conversations at Community Health Centers. Journal of general internal medicine, 37(1), 130–136. https://doi.org/10.1007/s11606-021-06921-3

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

34327652

Department(s)

Administration and Leadership

Document Type

Article