Medical practitioners' experiences of and attitudes towards goals of patient care discussions: A cross-sectional survey.

Abstract

The aging population is projected to significantly increase by 2066, with a corresponding rise in individuals experiencing chronic illnesses and approaching the end of life (EoL). Many patients prefer to receive care at home, but a substantial proportion still die in institutional settings, including intensive care units (ICUs). Goals of Patient Care (GoPC) discussions aim to promote shared decision-making and improve EoL care, ultimately improving patient outcomes and reducing unnecessary interventions. However, there is limited understanding of medical practitioners' experiences and perceptions of GoPC discussions. To explore the attitudes, experiences, barriers, and training needs of medical practitioners regarding GoPC discussions in Western Australia (WA). A cross-sectional survey was conducted with 273 medical practitioners. Participants reported varied levels of confidence in conducting GoPC discussions. Barriers such as inadequate training, time constraints, and family members' difficulty accepting prognosis were identified as significant challenges. A substantial proportion (89.6 %) of participants had not received formal GoPC training, and 58.8 % expressed a need for further education, with workshops and scenario-based learning preferred. While the majority reported confidence in recognizing when GoPC discussions were required, this contrasted with limited training and persistent systemic barriers, suggesting a gap between perceived readiness and effective implementation in practice. Findings highlight the need for targeted education, mentorship, and systemic support to improve GoPC discussions, with a focus on addressing barriers related to time, training, and communication with patients and families. Future research should investigate the nature of GoPC discussions, including practitioner confidence and the impact of training on patient and family outcomes, as well as explore the roles of allied health professionals in these discussions.