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Title: The ostrich approach - Prognostic avoidance, strategies and barriers to assessing older hospital patients' risk of dying.
Austin Authors: Gerber, Katrin;Hayes, Barbara;Bloomer, Melissa J;Perich, Carol;Lock, Kayla;Slee, Jo-Anne;Lee, Dr Cik Yin;Yates, Dr Paul
Affiliation: Geriatric Medicine..
Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, VIC, 3220 Australia..
School of Nursing and Midwifery, Griffith University, Griffith, QLD, 4222 Australia..
Ageing, Cancer and Continuing Care Division, Western Health, Williamstown VIC, 3016 Australia..
Melbourne Ageing Research Collaboration, National Ageing Research Institute, Parkville VIC, 3052 Australia..
Quality, Improvement and Patient Experience, The Royal Melbourne Hospital, Parkville VIC, 3052 Australia..
Centre for Medicine Use and Safety, Monash University; Parkville VIC, 3052 Australia..
Department of Nursing, University of Melbourne, Parkville VIC, 3052 Australia..
Melbourne School of Psychological Science, University of Melbourne, Parkville VIC, 3010.. Australia
Intensive Care Unit, Princess Alexandra Hospital, Woolloongabba, QLD, 4102 Australia..
Cancer Services, Northern Health, Bundoora VIC, 3083 Australia..
Northern Clinical School, University of Melbourne, Bundoora VIC, 3083 Australia..
School of Nursing and Midwifery, Deakin University, Geelong, VIC, 3220, Australia..
Issue Date: Jul-2022
Date: 2022-05-31
Publication information: Geriatric nursing 2022; 46: 105-111
Abstract: Predicting older patients' life expectancy is an important yet challenging task. Hospital aged care assessment teams advise treating teams on older patients' type and place of care, directly affecting quality of care. Yet, little is known about their experiences with prognostication. Twenty semi-structured interviews were conducted with seven geriatricians/ registrars, ten nurses and three allied health staff from aged care assessment teams across two hospitals in Melbourne, Australia. Data were analysed thematically. To generate prognoses, clinicians used analytical thinking, intuition, assessments from others, and pattern matching. Prognostic tools were an underutilised resource. Barriers to recognition of dying included: diffusion of responsibility regarding whose role it is to identify patients at end-of-life; lack of feedback about whether a prognosis was correct; system pressures to pursue active treatment and vacate beds; avoidance of end-of-life discussions; lack of confidence, knowledge and training in prognostication and pandemic-related challenges.
DOI: 10.1016/j.gerinurse.2022.05.004
ORCID: 0000-0001-9317-0145
Journal: Geriatric nursing (New York, N.Y.)
PubMed URL: 35659649
PubMed URL:
Type: Journal Article
Subjects: Prognosis
end of life
geriatric assessment
palliative care
qualitative research
Appears in Collections:Journal articles

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