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Clinicians’ and public acceptability of universal risk-of-death screening for older people in routine clinical practice in Australia: cross-sectional surveys

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Abstract

Background

Clinicians’ delays to identify risk of death and communicate it to patients nearing the end of life contribute to health-related harm in health services worldwide. This study sought to ascertain doctors, nurses and senior members of the public’s perceptions of the routine use of a screening tool to predict risk of death for older people.

Methods

Cross-sectional online, face-to-face and postal survey of 360 clinicians and 497 members of the public.

Results

Most (65.9%) of the members of the public welcomed (and 12.3% were indifferent to) the use of a screening tool as a decision guide to minimise overtreatment and errors from clinician assumptions. Supporters of the use of a prognostic tool were likely to be males with high social capital, chronically ill and who did not have an advance health directive. The majority of clinicians (75.6%) reported they were likely or very likely to use the tool, or might consider using it if convinced of its accuracy. A minority (13.3%) stated they preferred to rely on their clinical judgement and would be unlikely to use it. Differentials in support for tools by seniority were observed, with more support expressed by nurses, interns and registrars than medical specialists (χ2 = 12.95, p = 0.044) and by younger (< 40 years) clinicians (81.2% vs. 71.2%, p = 0.0058).

Discussion

The concept of integrating prognostication of death in routine practice was not resisted by either target group.

Conclusion

Findings indicate that screening for risk of death is seen as potentially useful and suggests the readiness for a culture change. Future research on implementation strategies could be a step in the right direction.

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Acknowledgements

We are indebted to the members of the public, residents of aged-care facilities, nurses and doctors who took the time to share their views with us to help us understand their perspective; and we are grateful to the hospitals and aged-care service managers who enabled data collection at their facilities. Nurses Amanda Ashton and Laura Hanly assisted with early data collection at aged-care facilities.

Funding

This work was supported by Australian National Health and Medical Research Council [NHMRC #1054146]. The funders played no role in the design, execution, analysis and interpretation of data, or writing of the study.

Author information

Authors and Affiliations

  1. School of Public Health and Community Medicine, The University of New South Wales, Level 3, Samuels Building, Gate 11, Botany Street, UNSW Sydney Campus, Sydney, NSW, 2052, Australia

    Ebony T. Lewis & Reema Harrison

  2. School of Psychology, The University of New South Wales, Mathews Building Gate 11, Botany Street, UNSW Sydney Campus, Sydney, NSW, 2052, Australia

    Ebony T. Lewis

  3. South Western Sydney Clinical School, The University of New South Wales, Level 2, Education Building Liverpool Hospital, Cnr Elizabeth and Goulburn Streets, Liverpool, NSW, 2170, Australia

    Margaret Nicholson & Ken Hillman

  4. Intensive Care Unit, Liverpool Hospital, Level 2, Clinical Building Liverpool Hospital, Cnr Elizabeth and Goulburn Streets, Liverpool, NSW, 2170, Australia

    Margaret Nicholson & Ken Hillman

  5. Department of General Practice, Medical School, Western Sydney University, Building 30, Campbelltown Campus, Corner of Narellan Road and Gilchrist Drive, Campbelltown, NSW, 2560, Australia

    Steven Trankle

  6. Gold Coast Hospital and Health Service, Professorial Unit Level 2, PED Building E, 1 Hospital Boulevard, Southport, QLD, 4215, Australia

    Shirley Rangel & Magnolia Cardona

  7. Griffith Health Clinics, Griffith University, Levels 3 and 4, Griffith Health Centre (G40), Gold Coast Campus, Cnr Parklands Drive and Olsen Ave, Southport, QLD, 4215, Australia

    Claire Stokes

  8. Institute for Evidence-Based Healthcare, Bond University, Level 4, HSM 5, 14 University Drive, Gold Coast, QLD, 4229, Australia

    Magnolia Cardona

  9. Neuroscience Research Australia, NeuRA, Margarete Ainsworth Building, Barker Street, Randwick, NSW, 2031, Australia

    Ebony T. Lewis

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  1. Ebony T. Lewis
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Contributions

Conception and design: MC, EL, MN, KH. Data collection, analysis and/or interpretation of data: MC, EL, SR, ST, MN, RH. Drafting of the article and/or critical revision for important intellectual content: EL, MC, SR, CS, KH. All other authors made a substantial contribution to subsequent versions. Approval of the version to be published: all authors.

Corresponding author

Correspondence to Ebony T. Lewis.

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Conflict of interest

The authors declare that they have no conflict of interests.

Ethical approval

Ethical approval for the clinicians’ survey was granted by the University of New South Wales Research Ethics Advisory Panel (project #HC15177). The survey of the general public was endorsed by the Human Research Ethics Advisory (HREA) Panel G: Medical and Community, of The University of New South Wales; (project HC #15081).

Informed consent

All participants completed a single consent question online after reading the purpose of the survey and before proceeding with the questionnaire.

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Lewis, E.T., Harrison, R., Nicholson, M. et al. Clinicians’ and public acceptability of universal risk-of-death screening for older people in routine clinical practice in Australia: cross-sectional surveys. Aging Clin Exp Res 33, 1063–1070 (2021). https://doi.org/10.1007/s40520-020-01598-w

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  • DOI: https://doi.org/10.1007/s40520-020-01598-w

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