Discussions of "code status" on a family practice teaching ward: What barriers do family physicians face?

Background: Patients want physicians to ascertain their wishes related to r esuscitation, yet such discussions of "code status" are often delayed in th e hospital setting, which compromises patient autonomy. Few studies have ex amined family physicians' views on this topic. Our objectives were to explo re the experiences of family physicians and family practice residents in es tablishing Code status with their patients who had been admitted to hospita l and to identify barriers to these discussions. Methods: Semistructured, in-depth interviews were conducted with 5 family p hysicians and 5 family practice residents admitting patients to a family pr actice teaching ward in a university-affiliate urban tertiary care hospital , interview transcripts were analysed inductively, and grounded theory was used to identify conceptual categories and recurring themes. Key findings w ere validated by means of member checking with participants; consensus meet ings of the research team and consultation with qualitative researchers. Results: Barriers to code-status discussions included personal discomfort w ith:confronting mortality, fear of damaging the doctor-patient relationship or harming the patient by raising the topic of death, limited time to esta blish trust, and difficulty in managing complex family dynamics. In spite o f these challenges, family physicians and residents viewed discussions of r esuscitation as a significant part of their role. Interpretation: Family physicians and residents need to,develop personal aw areness about difficulties in confronting mortality, enhance-their communic ation strategies for broaching the topic of code status in the context of a trusting doctor-patient relationship and sharpen their skills in understan ding and managing family dynamics related to end-of-life decisions. Awarene ss of the barriers to code-status discussions can inform research, educatio n and hospital policy. Consultation with patients is needed to develop effe ctive communication strategies.