Clinician Perspectives on Challenges to Patient Centered Care at the End of Life

Shoshana H. Bardach, Edward J. Dunn, J. Christopher Stein

Research output: Contribution to journalReview articlepeer-review

8 Scopus citations


Discussions regarding patient preferences for resuscitation are often delayed and preferences may be neglected, leading to the receipt of unwanted medical care. To better understand barriers to the expression and realization of patients' end of life wishes, a preventive ethics team in one Veterans Affairs Medical Center conducted a survey of physicians, nurses, social workers, and respiratory therapists. Surveys were analyzed through qualitative analysis, using sorting methodologies to identify themes. Analysis revealed barriers to patient wishes being identified and followed, including discomfort conducting end-of-life discussions, difficulty locating patients' preferences in medical records, challenges with expiring do not resuscitate (DNR) orders, and confusion over terminology. Based on these findings, the preventive ethics team proposed new terminology for code status preferences, elimination of the local policy for expiration of DNR orders, and enhanced systems for storing and retrieving patients' end-of-life preferences. Educational efforts were initiated to facilitate implementation of the proposed changes.

Original languageEnglish
Pages (from-to)401-415
Number of pages15
JournalJournal of Applied Gerontology
Issue number4
StatePublished - Apr 1 2017

Bibliographical note

Publisher Copyright:
© The Author(s) 2015.


  • end of life
  • ethics
  • patient care planning
  • qualitative research

ASJC Scopus subject areas

  • Gerontology
  • Geriatrics and Gerontology


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