Healthcare Professionals' Wishes Toward End-of-Life Conversations: A Descriptive Correlational Study (ConVita Study)

Abstract

Objective: End-of-life conversations could improve anxiety, depression, and quality of life of patients and their families. Most patients believe it is important to discuss prognosis with their healthcare professionals, however only a minority reports to do so. The aim of this study was to describe healthcare professionals' wishes regarding end-of-life if they were in hypothetical end-of-life condition.

Methods: In this descriptive-correlational study, 467 healthcare providers were selected using the census sampling method. Physicians, nurses, or nursing assistants who worked in the oncohematology, internal medicine, intermediate care, surgical areas, or hospices of three hospitals in the northwest of Italy were included. All participants were included if they agreed to participate in the study and signed a written informed consent. A modified version of the guide "Your Conversation Starter Kit," the ConVita Questionnaire, was used. A logistic regression to analyze possible associations between personal and professional characteristics and end-of-life wishes of healthcare professionals was performed.

Results: Of the 747 professionals who agreed to participate, 467 questionnaires were returned. Compared to physicians, nurses (OR = 2.551 [95% CI 1.306-4.982], P = .006) and nursing assistants (OR = 2.755 [95% CI 1.218-6.23], P = .015) were more likely to prefer receiving treatments regardless the discomfort these might cause. This was less likely to occur when professionals attended palliative care courses (OR = 0.655 [95% CI 0.431-0.997], P = .048). Professionals with longer working experience in the same unit were more likely to give more importance to the quality of life than to the amount of medical care (OR = 1.041 [95% CI 1.006-1.078], P = .022). Compared to physicians, nurses were more likely to worry about not receiving sufficient treatments (OR = 2.883 [95% CI 1.526-5.446], P = .001).

Conclusions: This study contributes to a better understanding of healthcare professionals' wishes if they were in the hypothetical condition of end of life. Healthcare professionals need support to gain insight into end-of-life issues.

Implication for nursing practice: By better understanding healthcare professionals' perspective on end of life, this study may help build the support they need to feel better equipped to address end-of-life conversations with patients and families. Palliative care courses may raise healthcare professionals' awareness toward a timely start of end-of-life conversations.

Keywords: communication; end of life; end-of-life conversations; healthcare professionals; palliative care.