Cultural Adaptation and Acceptability of the Crisis Conversation Guide by Emergency Physicians for Serious Illness Patients: Mixed Methods Study
Thidathit Prachanukool¹,²,³, Thavinee Trinarongsakul³, Thapanawong Mitsungnern⁴, Natthakorn Pongsettakul⁵, Attakorn Raksasataya⁶, Thiti Wongtangman⁷, Kittiphon Nagaviroj⁵, Pratamaporn Chanthong⁸, Sarayut Kahapana⁹, Hannah Oelschlager¹, Scott David Stonington¹⁰, Kei Ouchi¹,²,¹¹
Affiliation : ¹ Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA; ² Harvard Medical School, Boston, Massachusetts, USA; ³ Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; ⁴ Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; ⁵ Department of Family Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; ⁶ Karunruk Palliative Care Center, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; ⁷ Department of Emergency Medicine, Lerdsin General Hospital, Bangkok, Thailand; ⁸ Siriraj Palliative Care Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; ⁹ Simulation Training Center, Bangkok Hospital Phuket, Phuket, Thailand; ¹⁰ Department of Internal Medicine and Anthropology, University of Michigan, Ann Arbor, Michigan, USA; ¹¹ Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
Background: During a medical crisis, emergency physicians often discuss life-saving interventions with seriously ill patients and their families. Crisis conversations require strong communication skills and a patient-centered approach.
Objective: To culturally adapt and assess the acceptability of an existing English crisis conversation guide for use by emergency physicians in Thailand.
Materials and Methods: A three-stage mixed-method study was conducted. The initial stage included the translation and cultural adaptation of an English crisis conversation guide to Thai using a modified Delphi method with an expert panel’s consensus. The expert panel included four emergency physicians and four palliative care clinicians. The second stage involved surveying Thai emergency physicians on the perceived necessity of each step of the conversation guide using a 5-point Likert scale. In the third stage, the expert panel reviewed the survey results and incorporated feedback to produce the final Thai crisis conversation guide.
Results: The Thai crisis conversation guide was initially adapted from the English original via Thai word adaptation and practical rearrangement. In the refinement stage, the expert panel modified several strategies for exploring patient values and added a new step to the conversation guide, which the authors term “gathering the decision makers”. The acceptability survey was completed by 180 Thai emergency physicians, with a 36% response rate. These physicians reported that the step with the strongest perceived necessity in the conversation guide was “summarize goal of care” with 176 participants (98%) responding “agree” and “strongly agree”.
Conclusion: The crisis conversation guide was culturally adapted for clinical practice in Thailand. More than 88% of Thai emergency physicians reported the conversation guide to be acceptable in their clinical practice.
Received 2 April 2025 | Revised 15 October 2025 | Accepted 20 October 2025
DOI: 10.35755/jmedassocthai.2025.12.951-960-02998
Keywords : Communication; Emergency medicine; Serious illness conversation; Palliative care; Crisis conversation; Goal of care conversation
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