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

Abstract

Background: Clinicians{\textquoteright} 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{\textquoteright}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 (χ 2 = 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.