468 IMPROVING ADVANCE CARE PLANNING SKILLS IN JUNIOR DOCTORS

2021 ◽  
Vol 50 (Supplement_2) ◽  
pp. ii8-ii13
Author(s):  
S Cohen ◽  
R Singh ◽  
N Khalid ◽  
J Young ◽  
M Aldiwani ◽  
...  
Keyword(s):  
Advance Care Planning ◽  
Training Session ◽  
Skills Training ◽  
Junior Doctors ◽  
Care Planning ◽  
Health Care Planning ◽  
Difficult Conversations ◽  
Discharge Letter ◽  
Advance Care ◽  
And Training

Abstract Introduction Junior doctors are increasingly encountering Advance Care Planning (ACP) when they look after frail, older or multi-morbid patients during their hospital rotations. However, there remains a lack of formal training and resources, particularly with DNACPR discussions and when engaging patients and their loved ones with Emergency Health Care Planning (EHCP). We aimed to assess the need for ACP, improve the infrastructure by which ACP is delivered, and better support junior doctors to have these difficult conversations. Method Discharges from the Geriatrics Department at Kettering General Hospital were reviewed initially in May 2019 and again in January 2020 following intervention. We introduced a focused communication skills training session delivered at departmental teaching, which included a combination of simulation training and lectures. We additionally designed and implemented an EHCP template to aid junior doctors’ discussions. This could also be copied to the discharge letter, to facilitate safe transfer of care to primary care. Results In May 2019 of 32 patients, 100% met at least one SPICTTM criterion, with median of 4 criteria, thus indicating a high need for ACP in this cohort. Despite this, only one discharge letter included an EHCP and two had a request for GP colleagues to complete one. Evaluation of discharges again in January of 2020 reconfirmed a similar need for ACP, but following our interventions, the number of EHCP’s performed had increased. Of 22 identified patients 4 had a completed EHCP and 3 were requested for completion by their GP. Qualitative questionnaires demonstrated an improvement in both knowledge and confidence amongst junior doctors following the training session. Conclusion We have shown that there is a necessity for ACP to be considered for Geriatrics inpatients, and that providing structure and training in this challenging area offers benefit to both patients and junior doctors.

Engaging College Undergraduates in Advance Care Planning

2016 ◽  
Vol 74 (3) ◽  
pp. 329-344 ◽  
Author(s):  
Sara Sanders ◽  
Erin L. Robinson
Keyword(s):  
Advance Care Planning ◽  
End Of Life Care ◽  
Care Planning ◽  
Life Care ◽  
Health Care Planning ◽  
Medical Decisions ◽  
Care Plans ◽  
Life Threatening ◽  
Advance Care

Advance care planning (ACP) is a critical part of long-term health-care planning, as no one knows when the ability to make personal medical decisions may be impaired. Many assume ACP is only necessary for older adults or those with life-threatening health conditions; however, there are growing discussions about healthy, young adults also engaging in ACP, as they too suffer from unexpected medical events that limit their ability to make medical decisions. The current study examined the reactions of college students following the completion of their advance care plans and then sharing these plans with friends and family. The students reported that while completing their advance care plans created many emotions, they found the experience to be valuable and facilitated conversations with family and friends about end-of-life care that may not have occurred otherwise.

scholarly journals Nurse Practitioner Perspectives on the Barriers and Facilitators of Advance Care Planning

2017 ◽  
Author(s):  
Cherish Dellava
Keyword(s):  
Advance Care Planning ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
The United States ◽  
Education And Training ◽  
Barriers And Facilitators ◽  
Care Planning ◽  
Advance Care ◽  
Eol Care ◽  
And Training

<p>Every year, thousands of residents in the United States die while receiving end of life (EOL) care that is inconsistent with their wishes. Research evidence has shown that advance care planning (ACP) improves congruity between patients’ preference and actual care received at EOL. Despite medical guidelines supporting ACP, these discussions rarely occur. The purpose of this study was to explore the perspectives of nurse practitioners (NPs) on the barriers and facilitators of ACP. The web-based ACP survey was distributed to the members of the New Hampshire Nurse Practitioner Association (NHNPA). The participants (n = 65) were mostly women (96.9%), had a Master’s degree (83.1%), and had 16 to 25 years of practice as NPs (37.5%). Results indicated that the most common barriers to ACP were related to time including type of appointment, lack of time, and length of appointment. The most common facilitators were personal experience, comfort with the topic, long-term relationship with the patient, and previous education and training. Implications for advance nursing practice include conducting research on the patients’ perspective on ACP, and development of evidence-based tools and methods to facilitate ACP discussions. Improving education and training of healthcare providers on ACP and EOL care issues, increasing advocacy for payment and scheduling systems that facilitate ACP, supporting policies that require ACP to patients with chronic, progressive or terminal conditions, and improving public awareness of ACP are recommended.</p>

scholarly journals Development of a Community Advance Care Planning Guides Program and the RELATE Model of Communication

2019 ◽  
Vol 37 (1) ◽  
pp. 5-11 ◽  
Author(s):  
Carey Candrian ◽  
Susan Lasker Hertz ◽  
Daniel Matlock ◽  
Lierin Flanagan ◽  
Channing Tate ◽  
...  
Keyword(s):  
Communication Skills ◽  
Advance Care Planning ◽  
Retention Rate ◽  
Skills Training ◽  
Care Planning ◽  
Structured Interviews ◽  
Community Based ◽  
Direct Observations ◽  
Hospice Volunteers ◽  
Advance Care

Objective: Quality communication is an important aspect of advance care planning (ACP). This study evaluates a certification program that trains lay people in communication skills to support community-based ACP conversations. Methods: The program was developed with an emphasis on communication skills training. The testing of the program included ACP Guides and conversation partners, who were hospice volunteers, to assess the use of communication skills in ACP conversations. The evaluation used direct observations of conversations between trained ACP Guides and conversation partners as well as semi-structured interviews with those trained to become ACP Guides and those participating in the conversation. Results: Twenty-two ACP Guides participated in the testing phase with a retention rate of 100% completing all 4 sessions. The RELATE model of communication emerged during program development and testing. Evaluation of 15 ACP Guides having ACP conversations found that trained ACP Guides could use the RELATE model of communication to support ACP conversations. Conclusion: A community–academic partnership developed an ACP Community Guides Program that trained individuals to have community-based ACP conversations. Next steps include additional testing of the program and RELATE in small numbers, especially among minority populations, to evaluate acceptability and usability of this approach. Practice Implications: Laypersons with concrete communication skills can facilitate effective peer-to-peer ACP conversations.

scholarly journals Training Clinic Providers on Advance Care Planning Improves Provider Self-Efficacy

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 768-768
Author(s):  
Jeffrey Graupner ◽  
Sandy Tun ◽  
Carolyn Read ◽  
Amena Qureshi ◽  
Cassie Lee ◽  
...  
Keyword(s):  
Advance Care Planning ◽  
Self Efficacy ◽  
Underserved Populations ◽  
Training Session ◽  
Rank Test ◽  
Care Planning ◽  
Training Clinic ◽  
Before And After ◽  
Signed Rank Test ◽  
Advance Care

Abstract Advance care planning (ACP) is a vital step to ensure patients receive and prioritize the care that best aligns with their end-of-life wishes, including discussion and documentation of an advance directive. Significant gaps in ACP among underserved populations have been well documented. Research suggests a successful strategy for increasing the communication between provider and patient about ACP is to educate clinicians on this important issue. Three, 2.5 hour training sessions were provided to healthcare staff of a large chain of older adult primary care clinics across three states. Lecture materials were created and presented by a palliative care (PC) physician and PC nurse practitioner. Presentations were held both in person and virtually. Participants were asked to complete a pre/post-training survey online which included a validated 17-item ACP Self-Efficacy Scale (Baughman, 2017), perceived barriers checklist, and additional quality improvement measures. A total of 131 providers attended one of three training sessions. 76 providers (58.0%) and 47 providers (35.9%) completed pre- and post-training surveys respectively. Scores on a 17-item validated ACP Self-Efficacy Scale were significantly higher after training (Wilcoxon signed rank test, Z= 4.42, p &lt;.001). Participants ranked “lack of time” as the number one barrier to having ACP conversations both before and after the training, whereas “lack of training” ranked 2nd and fell to 7th after the training. These initial results suggest ACP self-efficacy among providers can be increased through a one-time training session. Previous literature has highlighted the importance of provider self-efficacy as factor in increasing ACP conversations with patients.

scholarly journals Evaluating an Advance Care Planning Skills Training for Medical, Nursing, and Social Work Students

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 243-243
Author(s):  
Todd Becker ◽  
John Cagle
Keyword(s):  
Social Work ◽  
Advance Care Planning ◽  
Self Efficacy ◽  
Repeated Measures ◽  
Social Work Students ◽  
Skills Training ◽  
Self Report ◽  
Care Planning ◽  
Interprofessional Teamwork ◽  
Advance Care

Abstract Advance care planning (ACP) helps to ensure future healthcare is congruent with individual preferences. Curricula for health-focused professions rarely include ACP content. This is a repeated measures evaluation of an innovative, interprofessional student training to enhance the ability to lead ACP discussions. Outcomes were measured via self-report surveys at two timepoints (baseline = T1 [n = 35]; posttraining follow-up = T2 [n = 20]) and included validated measures of communication self-efficacy, ACP self-efficacy, and interprofessional teamwork. Data collection from a third timepoint (T3), following randomized group assignment is currently underway. The matched T1–T2 sample (N = 17) included students from medicine (64.7%), nursing (17.6%), and social work (17.6%). Participants were largely young (M=26 years), non-Hispanic (94.0%), White (59.0%), and female (71.0%). Paired t tests examined change from T1 to T2 for all outcomes. Despite worse communication self-efficacy (Mdiff=1.6, p&lt;.001) and ACP self-efficacy (Mdiff=.92, p&lt;.001), perceptions of interprofessional teamwork improved (Mdiff=3.0, p=.008). These T1–T2 findings mirror results from similar, prior research, which subsequently discovered that both self-efficacy outcomes and their effect sizes for change worsened at T2, but ultimately and substantially improved at T3. These fluctuations suggest participants initially overestimated their self-efficacy related to ACP at T1 and corrected their appraisals at T2. Other studies should account for this self-correction. Further replication is needed to understand the dip that appears to occur before anticipated improvements occur.

scholarly journals Medical-Legal Partnerships to Enhance Residency Training in Advance Care Planning

2019 ◽  
Vol 51 (4) ◽  
pp. 353-357
Author(s):  
Jessie M. Pettit ◽  
Anne M. Ryan ◽  
Julie Armin ◽  
Barry D. Weiss
Keyword(s):  
Advance Care Planning ◽  
Primary Care Physicians ◽  
Training Session ◽  
Care Planning ◽  
Evaluation Tool ◽  
Direct Observations ◽  
Working Together ◽  
Developmental Scale ◽  
Advance Care ◽  
Performance Results

Background and Objectives: Only about one-third of adult Americans have completed advance directives for end-of-life care, and primary care physicians report that they are not always comfortable discussing advance care planning (ACP) with patients. Current approaches to teaching clinicians about ACP have limited evidence of effectiveness. With the objective of improving residents’ comfort and skill discussing ACP with patients, we developed a curriculum that involved clinicians and attorneys working together to teach first-year family medicine residents (R1) about leading ACP discussions with patients. Methods: Our curriculum consisted of a 1-hour multimedia training session on ACP followed by a series of direct in-exam room observations. Attorney and/or physician faculty observed residents holding ACP discussions with patients and provided structured feedback to residents about their performance. The initial R1 cohort observed had a series of three direct observations; the subsequent R1 cohort had two direct observations. We developed an evaluation tool with a 5-point developmental scale (beginner, novice, developing, near mastery, mastery) corresponding to the Accreditation Council for Graduate Medical Education’s milestone system to score residents’ performance. Results: R1 performance improved from the beginner/novice level during the first observed ACP discussion to the novice/developing level during the second or third discussion, representing an increase in competence to that expected of a second- or early third-year resident. Conclusion: Based on our initial experience, using medical-legal partnerships to teach residents about ACP may be more effective than previously reported approaches. Validation of our results with a larger sample is needed.

scholarly journals Advance Care Planning: Promoting Effective and Aligned Communication in the Elderly (ACP-PEACE): the study protocol for a pragmatic stepped-wedge trial of older patients with cancer

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e040999
Author(s):  
Joshua R Lakin ◽  
Elise N Brannen ◽  
James A Tulsky ◽  
Michael K Paasche-Orlow ◽  
Charlotta Lindvall ◽  
...  
Keyword(s):  
Advance Care Planning ◽  
Older Patients ◽  
Randomised Trial ◽  
Skills Training ◽  
The Elderly ◽  
Care Planning ◽  
Stepped Wedge ◽  
Original Design ◽  
Patients With Cancer ◽  
Advance Care

IntroductionAdvance care planning (ACP) is associated with improved health outcomes for patients with cancer, and its absence is associated with unfavourable outcomes for patients and their caregivers. However, older adults do not complete ACP at expected rates due to patient and clinician barriers. We present the original design, methods and rationale for a trial aimed at improving ACP for older patients with advanced cancer and the modified protocol in response to changes brought by the COVID-19 pandemic.Methods and analysisThe Advance Care Planning: Promoting Effective and Aligned Communication in the Elderly study is a pragmatic, stepped-wedge cluster randomised trial examining a Comprehensive ACP Program. The programme combines two complementary evidence-based interventions: clinician communication skills training (VitalTalk) and patient video decision aids (ACP Decisions). We will implement the programme at 36 oncology clinics across three unique US health systems. Our primary outcome is the proportion of eligible patients with ACP documentation completed in the electronic health record. Our secondary outcomes include resuscitation preferences, palliative care consultations, death, hospice use and final cancer-directed therapy. From a subset of our patient population, we will collect surveys and video-based declarations of goals and preferences. We estimate 11 000 patients from the three sites will be enrolled in the study.Ethics and disseminationRegulatory and ethical aspects of this trial include Institutional Review Board (IRB) approval via single IRB of record mechanism at Dana-Farber Cancer Institute, Data Use Agreements among partners and a Data Safety and Monitoring Board. We plan to present findings at national meetings and publish the results.Trial registration numberNCT03609177; Pre-results.

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