scholarly journals ADVANCE CARE PLANNING COMMUNICATION: AN INTERACTIVE WORKSHOP WITH ROLE-PLAY FOR STUDENTS AND PRIMARY CLINICIANS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S846-S846
Author(s):  
Ben A Blomberg ◽  
Catherine Quintana ◽  
Jingwen Hua ◽  
Leslie Hargis-Fuller ◽  
Jeff Laux ◽  
...  
Keyword(s):  
Primary Care ◽  
Medical Students ◽  
Advance Care Planning ◽  
Role Play ◽  
Primary Care Providers ◽  
Care Planning ◽  
Care Providers ◽  
Clinician Training ◽  
Primary Care Clinics ◽  
Advance Care

Abstract There is a need for increased clinician training on advance care planning (ACP). Common barriers to ACP include perceived lack of confidence, skills, and knowledge necessary to engage in these discussions. Furthermore, many clinicians feel inadequately trained in prognostication. There is evidence that multimodality curricula are effective in teaching ACP, and may be simultaneously targeted to trainees and practicing clinicians with success. We developed a 3-hour workshop incorporating lecture, patient-oriented decision aids, prognostication tools, small group discussion, and case-based role-play to communicate a values-based approach to ACP. Cases included discussion of care goals a patient with severe COPD and one with mild cognitive impairment. The workshop was delivered to 4th year medical students, then adapted in two primary care clinics. In the clinics, we added an interprofessional case applying ACP to management of dental pain in advanced dementia. We evaluated the workshops using pre-post surveys. 34 medical students and 14 primary care providers participated. Self-reported knowledge and comfort with ACP significantly improved; attitudes toward ACP were strongly positive both before and after. The workshop was well received. On a seven-point Likert scale, (1=Unacceptable, 7=Outstanding), the median overall rating was 6 (“Excellent”). In conclusion, we developed an ACP workshop applicable to both students and primary clinicians. We saw improvements in self-reported knowledge and comfort with ACP, though long-term effects were not studied. Participants found the role-play especially valuable. Most modifications for primary care clinics focused on duration rather than content. Future directions include expanding the interprofessional workshop content.

scholarly journals Provider Perspectives on Advance Care Planning Documentation in the Electronic Health Record: The Experience of Primary Care Providers and Specialists Using Advance Health-Care Directives and Physician Orders for Life-Sustaining Treatment

2017 ◽  
Vol 34 (10) ◽  
pp. 918-924 ◽  
Author(s):  
Ellis Dillon ◽  
Judith Chuang ◽  
Atul Gupta ◽  
Sharon Tapper ◽  
Steve Lai ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Advance Care Planning ◽  
Primary Care Providers ◽  
Health Record ◽  
Care Planning ◽  
Care Providers ◽  
Life Sustaining Treatment ◽  
Advance Care ◽  
Advance Health Care Directives

Context: Advance care planning (ACP) is valued by patients and clinicians, yet documenting ACP in an accessible manner is problematic. Objectives: In order to understand how providers incorporate electronic health record (EHR) ACP documentation into clinical practice, we interviewed providers in primary care and specialty departments about ACP practices (n = 13) and analyzed EHR data on 358 primary care providers (PCPs) and 79 specialists at a large multispecialty group practice. Methods: Structured interviews were conducted with 13 providers with high and low rates of ACP documentation in primary care, oncology, pulmonology, and cardiology departments. The EHR problem list data on Advance Health Care Directives (AHCDs) and Physician Orders for Life-Sustaining Treatment (POLST) were used to calculate ACP documentation rates. Results: Examining seriously ill patients ≥65 years with no preexisting ACP documentation seen by providers during 2013 to 2014, 88.6% (AHCD) and 91.1% (POLST) of 79 specialists had zero ACP documentations. Of 358 PCPs, 29.1% (AHCD) and 62.3% (POLST) had zero ACP documentations. Interviewed PCPs often believed ACP documentation was beneficial and accessible, while specialists more often did not. Specialists expressed more confusion about documenting ACP, whereas PCPs reported standard clinic workflows. Problems with interoperability between outpatient and inpatient EHR systems and lack of consensus about who should document ACP were sources of variations in practices. Conclusion: Results suggest that providers desire standardized workflows for ACP discussion and documentation. New Medicare reimbursement for ACP and an increasing number of quality metrics for ACP are incentives for health-care systems to address barriers to ACP documentation.

How do Dutch primary care providers overcome barriers to advance care planning with older people? A qualitative study

2018 ◽  
Vol 36 (2) ◽  
pp. 219-224 ◽  
Author(s):  
Jolien J Glaudemans ◽  
Anja E de Jong ◽  
Bregje D Onwuteaka Philipsen ◽  
Jan Wind ◽  
Dick L Willems
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Older People ◽  
Advance Care Planning ◽  
Primary Care Providers ◽  
Care Planning ◽  
Care Providers ◽  
Advance Care

scholarly journals Advance Care Planning in Cancer: Patient Preferences for Personnel and Timing

2020 ◽  
Vol 16 (9) ◽  
pp. e875-e883 ◽  
Author(s):  
Boateng Kubi ◽  
Alexandra C. Istl ◽  
Kimberley T. Lee ◽  
Alison Conca-Cheng ◽  
Fabian M. Johnston
Keyword(s):  
Health Care Providers ◽  
Advance Care Planning ◽  
Patient Preferences ◽  
Primary Care Providers ◽  
Care Planning ◽  
Care Hospital ◽  
Care Providers ◽  
Oncology Patients ◽  
Advance Care ◽  
Do So

PURPOSE: Opportunities for advance care planning (ACP) discussions continue to be missed despite the demonstrated benefit of such conversations. This is in part because of a poor understanding of patient preferences. We aimed to determine oncology patients’ preferences surrounding ACP with a focus on the choice of which health care providers to have the conversation with and the timing of conversations. METHODS: A cross-sectional 19-question survey of surgical and medical oncology patients in a tertiary care hospital was conducted that assessed knowledge, experience, and preferences surrounding ACP. Quantitative variables were reported with descriptive statistics, and a coding structure was developed to analyze qualitative data. RESULTS: Two hundred patients were surveyed. Only 24% of patients reported previously having ACP discussions with their physicians despite 82.5% reporting a wish to do so. Patients felt that these discussions were a priority for them (to alleviate familial guilt, maintain control, and prevent others’ values from guiding end-of-life care), but they reported that previous experiences with ACP had been neither comprehensive nor effective. Most patients (43.5%) preferred to have ACP discussions with their primary care providers (PCPs) compared with 7% preferring their surgeon and 5.5% preferring their oncologist. Trust and familiarity with PCPs arose as the dominant theme underlying this selection. Most patients (94%) preferred to have ACP discussions early, with 45% wishing such a discussion had been initiated before their cancer diagnosis. CONCLUSION: Patients with cancer prefer to have ACP discussions with their PCPs and prefer to do so early in their disease course.

scholarly journals Educational Interventions to Improve Advance Care Planning Discussions, Documentation and Billing

2020 ◽  
pp. 104990912095108
Author(s):  
Cristine B. Henage ◽  
J. Marvin McBride ◽  
Joseph Pino ◽  
Jessica Williams ◽  
Jill Vedovi ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Advance Care Planning ◽  
Primary Care Providers ◽  
Educational Interventions ◽  
Care Planning ◽  
Interprofessional Team ◽  
Advance Care

Background/Objectives: To determine the impact of educational interventions, clinic workflow redesign, and quality improvement coaching on the frequency of advance care planning (ACP) activities for patients over the age of 65. Design: Nonrandomized before-and-after study. Setting: 13 ambulatory care clinics with 81 primary care providers in eastern and central North Carolina. Participants: Patients across 13 primary care clinics staffed by 66 physicians, 8 physician assistants and 7 family nurse practitioners. Interventions: Interprofessional, interactive ACP training for the entire interprofessional team and quality improvement project management with an emphasis on workflow redesign. Measurements: From July 2017 through June 2018—number of ACP discussions, number of written ACP documents incorporated into the electronic medical record (EMR), number of ACP encounters billed. Results: Following the interventions, healthcare providers were more than twice as likely to conduct ACP discussions with their patients. Patients were 1.4 times more likely to have an ACP document included in their electronic medical record. Providers were significantly ( p < 0.05) more likely to bill for an ACP encounter in only one clinic. Conclusions: Implementing ACP education for all clinic staff, planning for workflow changes to involve the entire interprofessional team and supporting ACP activities with quality improvement coaching leads to statistically significant improvements in the frequency of ACP discussions, the number of ACP documents included in the electronic medical record and number of ACP encounters billed.

scholarly journals Enhancing Advance Care Planning Communication: An Interactive Workshop With Role-Play for Students and Primary Care Clinicians

MedEdPORTAL ◽  
2020 ◽  
Vol 16 (1) ◽  
pp. 10973
Author(s):  
Ben A. Blomberg ◽  
Catherine Quintana ◽  
Jingwen Hua ◽  
Leslie Hargis-Fuller ◽  
Jeff Laux ◽  
...  
Keyword(s):  
Primary Care ◽  
Advance Care Planning ◽  
Role Play ◽  
Care Planning ◽  
Advance Care ◽  
Primary Care Clinicians ◽  
Interactive Workshop

Who, what, where, when, and how? Advance care planning documentation practices and accessibility in the electronic health record.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 2-2
Author(s):  
Evan Justin Walker ◽  
Ryan Mcmahan ◽  
Deborah Barnes ◽  
Mary Katen ◽  
Daniela Lamas ◽  
...  
Keyword(s):  
Primary Care ◽  
Electronic Health Record ◽  
Social Workers ◽  
Advance Directives ◽  
Advance Care Planning ◽  
Primary Care Providers ◽  
Health Record ◽  
Care Planning ◽  
Advance Care ◽  
Electronic Health

2 Background: Documenting patients’ advance care planning (ACP) wishes is essential to providing value aligned care, as is having this documentation readily accessible. Early ACP is increasingly being recognized as integral to oncologic care, however, little is known about current documentation practices. In this cross-sectional study, we describe ACP documentation practices and accessibility of documented ACP discussions in the electronic health record (EHR). Methods: Participants were recruited from outpatient clinics at the San Francisco VA, were ≥60 years old, with ≥2 chronic/serious conditions and ≥2 primary care visits in the past year. ACP documentation was abstracted from the EHR in 2013-2015 and included any prior legal forms/orders and ACP discussions documented within the prior five years. Frequency and type of ACP documentation was calculated using percentages and means. For discussions, author discipline and location of documentation was determined. Discussions were deemed “accessible” if documented in a designated ACP posting location or “not easily accessible” if recorded as free text in progress notes. Results: The mean age of 414 participants was 71 years (SD ± 8), 9% were women, 43% were non-white, and 51% had documented ACP including 149 (36%) with ACP forms and 138 (33%) with ACP discussions. Seventy-five (54%) discussions were documented by social workers and 49 (36%) by primary care providers. However, 76 (55%) discussions were not easily accessible. For 27 (18%) participants with advance directives, subsequent discussions documented a change in treatment preferences. Nineteen (70%) discussions reporting a change in wishes were not easily accessible. Conclusions: Half of chronically ill, older patients had documented ACP wishes, including a third with documented ACP discussions. Most discussions were documented by social workers and were not easily accessible, although discussions often represented changes from prior advance directives. Clinician education and EHR changes to ensure documented discussions are accessible are important patient-safety and quality improvement targets to ensure patients’ wishes are honored.

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