Religion, Faith, and Spiritual Beliefs in Documented Goals of Care Conversations Following Acute Stroke (RP109)

Outcomes 1. Identify key themes about religion, faith, and spirituality documented during goals of care conversations with acute stroke patients.2. Apply new knowledge about gaps in documenting goals of care conversations about religion, faith, and spirituality. Key Message This study analyzed the prevalence and themes of documented goals of care conversations about religion, faith, and spirituality. The study found infrequent documentation. Additionally, we found when patients expressed religious belief or spiritual value, there was little evidence that the team explored how these statements might affect care decisions. Importance Goals of care conversations (GOCC) are vital to patient-centered care, especially during an acute, unexpected medical event such as a severe ischemic stroke. There is a paucity in the literature regarding the frequency and depth in which religion, faith, or spiritual beliefs are addressed during GOCCs. Objective(s) To determine the content of religion, faith, or spiritual beliefs addressed during GOCCs documented by the interdisciplinary team in the patient's medical record. Scientific Methods Utilized A qualitative, thematic analysis of documented GOCC (dGOCC) was undertaken from a larger multicenter cohort study of patients suffering from an acute severe ischemic stroke. The parent study abstracted content of dGOCC from the medical records of 1297 patients and categorized the content into five domains of a GOCC, of which one domain was religion, faith, and spiritual beliefs. This study performed thematic analysis on the subset of patients with a dGOCC regarding religion, faith, and spiritual beliefs. Results Among the 1297 patients with a dGOCC, 47 (3.6%) patients had at least one dGOCC about religion, faith, or spiritual beliefs. Thematic analysis identified five themes within dGOCC: 1) the patient's or family's religion was identified; 2) religious or spiritual support was provided to the patient and or their family; 3) the role religion, faith, or spirituality plays in the patient's and/or their family's daily lives; 4) the role of religion, faith, or spirituality in coping with illness and/or the hospitalization; and 5) the role of religious or spiritual guidelines as an influence on patient preferences about medical care. Conclusion(s) dGOCC after severe ischemic stroke infrequently include information about a patient's or family's religion, spirituality, or faith. Among the few patients for which religion, faith, or spiritual beliefs were documented as being discussed, there was limited information about the implications of the role religion, faith, or spiritual beliefs played in the patient's medical care. Impact The results of this study indicate there are missed opportunities to discuss religion, faith, or spiritual beliefs with patients who have experienced an acute, unexpected medical event. Keywords Communication and prognostication/Psychosocial support