Abstract
BACKGROUND: Goals of care (GOC) discussions align medical care with patients' wishes. Many physician-associated barriers to GOC discussions have been identified, but there is little understanding of the lived experiences of patients and their nominated health care spokespersons (NHSs) who have participated in the discussion. OBJECTIVES: We aimed to describe the lived experience of participants of GOC discussions conducted during acute inpatient care and identify the features of well-conducted GOC discussions. METHODS: We conducted a qualitative enquiry based on grounded theory, employing a social-constructivist approach and interpretivist research paradigm. Participants were purposively sampled from the medical oncology, geriatric, and palliative medicine departments of a tertiary hospital in Singapore. Data was gathered using semi-structured interviews. RESULTS: A total of 24 interviews (16 NHS, 8 patients) were conducted. All participants were patients or NHS of patients who lived with a life-limiting illness (15 Cancer, 9 Non-cancer). The analysis yielded 2 major themes-Preconceived health perceptions and Desired communications skills-and 6 subthemes-Elusive knowledge, Emotional undertones, Existential struggles, Explicit clarity, Embracing empathy, and Enhancing autonomy. Well-conducted GOC discussions occurred when the participants' health perceptions were satisfied by a complementary communication skill employed by the physician, based on the model "Communicating to the Intellect, Heart, and Person." CONCLUSIONS: Well-conducted GOC discussions that facilitated consensus were discussions where the physician engaged the participant at three levels-the Intellect, Heart, and Person. Our model advocates for person-centered conversations where the views of the participant are heard and will provide insights to improve the conduct of GOC discussions.