Abstract
Studies support interventions directed at improving end-of-life (EOL) communication can enhance patient outcomes. There is insufficient evidence on appropriate, effective, and practical strategies to improve EOL dialogues with seriously ill patients. The Patient Preferences About Serious Illnesses (PASI) was developed to elicit patients' preferences when faced with serious illnesses. The purpose of this mixed-methods study is to understand nurse practitioners' (NPs) decision-making processes in determining when seriously ill patients are ready to discuss their care preferences and the effectiveness of the PASI in eliciting these EOL conversations. Participants of an NP state conference were invited to complete an online survey and engage in a focus group. Forty-seven NPs completed the online survey, and 13 participated in a focus group. Three themes emerged: (1) training, (2) barriers to EOL conversations, and (3) EOL experiences. Findings identified inconsistencies and need for improved evidence-based education in NP curricula on how to conduct EOL conversations. Participants felt the PASI was a promising tool that could assist in normalizing EOL conversations and eliciting patients' preferences. More research is needed to determine the PASI's usefulness and feasibility in multiple settings and patient populations.