Dr Elizabeth (Libby) Miller1,2, Professor Joanne Porter2, Dr Michael Barbagallo2
1College of Nursing and Health Sciences, Flinders University, Bedford Park, Australia, 2Collaborative Evaluation & Research Centre, Federation University Australia, Churchill, Australia
Biography:
Libby completed her PhD in nursing at Federation University in November 2023. Her research was embedded within the theory of Therapeutic Landscapes. She examined the environmental factors (natural, built, social, and symbolic) that may affect how people receive bad news regarding their life-limiting illness in the acute hospital environment. Libby has presented her work at the 21OPCC, PCNA 2022, EAPC 2023 and PCNA 2024 conferences and has multiple publications disseminating her research. Libby was a Research Fellow at Federation University and is now a casual academic and researcher at Flinders University within the College of Nursing and Health Sciences.
Abstract:
Background:
Documenting care and recording accurate details and outcomes of conversations between health professionals, patients, and family members is a crucial element of effective communication and is essential to meeting the requirements of person-centred care.
Aims:
The medical note audit aimed to:
(a) understand what type of information was recorded in the notes;
(b) explore how healthcare professionals document diagnostic/prognostic conversations in family meetings; and
(c) develop an understanding of the language used within the patients’ medical notes.
Methods:
After obtaining University and hospital ethical approval in March 2022, data were extracted from the electronic medical records of palliative patients regarding organised family meetings during hospital admissions in 2021 at a large regional hospital in Victoria. Tools were created to gather and analyse the data, using qualitative content analysis.
Results:
Seventeen family meeting notes were included in the final data set after examining 221 medical records. The audit revealed that health professionals (medical team/social workers) often used “soft” language or euphemisms instead of direct, clear language in their notes. Scant logistical meeting details were recorded; “death” was documented once, and “dying” not at all. “Palliative” was written 10 times but was mostly seen as a last resort. Alternatively, tests, plans, and prognosis were well documented, as was patient/family acknowledgment of having understood.
Conclusion:
Recommendations are that:
(a) Healthcare professionals receive more training on the role and benefit of palliative care services and introduce families earlier on the disease trajectory;
(b) Healthcare professionals are guided in writing consistent progress notes;
(c) The ANUM and/or ward nurse, be present at the family meeting to support the patient/family and hear first-hand what was spoken during the meeting;
(d) Emotional support be offered after bad news delivery and documented in the notes.