End-of-life (EOL) conversations in hospital should serve to give patients the opportunity to consider future treatment options and help them clarify their values and wishes before it becomes relevant to make decisions about treatment. However, it is known that EOL conversations are not performed systematically in hospital. This may mean that patients and their relatives do not address EOL issues. There is a lack of knowledge about who is responsible for conducting these conversations, and when and under what circumstances they are conducted. The aim of this study was to explore the existing practices regarding EOL conversations in an acute care hospital setting. The design was Interpretive Description and the methods for the data collection included: 1. Participatory observational studies in a pulmonary medical and surgical ward (a total of 66 h); 2. Four focus group interviews with healthcare professionals (n = 14) from the wards. The analysis followed Spradley’s ethnosemantic analysis. The results revealed three cultural categories related to: 1. The physical and organizational setting; 2. The timing of EOL conversations and competencies and roles in addressing EOL issues and 3. Topics addressed in EOL conversations. The EOL conversations were part of daily clinical practice, but there was a lack of competencies, roles were unclear and the physical and organizational environment was not conducive to the conversations. The topics of the EOL conversations revolved around a “here-and-now” status of the patient’s disease progression and decisions about the level of treatment. To a lesser extent, the conversations included the patient’s and relatives’ thoughts and wishes concerning EOL, which allowed long-term care planning. This study demonstrates that there are several barriers to talking about EOL in an acute care hospital setting, and future strategies must address an overall approach. In order to provide patients and their relatives with better opportunities to express their EOL wishes, there is a need for clearer roles and guidelines in an interdisciplinary approach to EOL conversations, alongside improved staff competencies and changes to the organizational and physical environment.

中文翻译：

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在一般性姑息治疗中谈论生命的尽头-这是怎么回事？丹麦一家急诊医院的临终对话的定性研究

在医院中进行的临终（EOL）对话应使患者有机会考虑将来的治疗方案，并帮助他们在决定治疗方案之前明确自己的价值观和愿望。但是，众所周知，在医院不会系统地进行EOL对话。这可能意味着患者及其亲属无法解决EOL问题。缺乏有关谁负责进行这些对话以及何时以及在什么情况下进行对话的知识。这项研究的目的是探讨在急诊医院环境中有关EOL对话的现有做法。设计为解释性描述，数据收集的方法包括：1.在肺内科和外科病房中进行的参与性观察研究（共66小时）；2.从病房对医疗保健专业人员（n = 14）进行了四个焦点小组访谈。该分析遵循Spradley的民族主义分析。结果揭示了与以下内容有关的三个文化类别：1.身体和组织环境；2. EOL对话的时间安排以及解决EOL问题的能力和角色； 3. EOL对话中讨论的主题。EOL对话是日常临床实践的一部分，但缺乏能力，角色不明确且身体和组织环境不利于对话。EOL对话的主题围绕患者疾病进展的“即刻”状态以及有关治疗水平的决定。在较小程度上，对话包括患者和亲戚关于EOL的想法和愿望，从而可以进行长期护理计划。这项研究表明，在急诊医院环境中谈论EOL存在多个障碍，并且未来的策略必须解决整体方法。为了向患者及其亲属提供更好的机会来表达其EOL的愿望，需要在跨学科的EOL对话方法中采用更清晰的角色和准则，同时还要提高员工的能力以及组织和自然环境的变化。