Dataset Information

Evaluating an Advance Care Planning Curriculum: a Lecture, a Game, a Patient, and an Essay.

ABSTRACT:

Purpose

Curricula on advance care planning are commonly absent or inadequate in the majority of medical schools. This study assessed an advance care planning mini-curriculum involving a lecture, an end-of-life conversation game, a patient encounter during which students facilitated completion of an advance directive, and a subsequent reflective essay.

Methods

This convergent, mixed methods study used a pre-post, longitudinal design. Confidence having end-of-life conversations was assessed at three timepoints. A linear mixed effects model compared mean confidence at the three timepoints. Focus groups and open-ended questionnaires (analyzed using content analysis) explored student perceptions of the curricula.

Results

Sixty-nine of 149 students completed the questionnaires; 18 students participated in the focus groups. Confidence scores increased by 10.3 points (+ 4.2 post-lecture/game; + 6.1 post-patient assignment/essay; p < 0.001 for all timepoints). Students felt the game (1) was a good "starting point" for learning to initiate end-of-life conversations; (2) fostered internal and external reflections about advance care planning; and (3) allowed exploration of the complexities of end-of-life discussions. Qualitative exploration suggested that high-level learning-interpreted through the lens of Bloom's taxonomy-occurred.

Conclusion

Mixed methods data suggest that the advance care planning mini-curriculum effectively increased student confidence having end-of-life conversations. Qualitative analyses revealed student learning covering all of tiers of Bloom's taxonomy.

SUBMITTER: Van Scoy LJ

PROVIDER: S-EPMC8368620 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Introduction/objectivesIn February 2019, recruitment began in Iowa Research Network offices for a Patient-Centered Outcomes Research Institute (PCORI) funded Advance Care Planning (ACP) study to be conducted in 7 primary care practice-based research networks across the United States and Canada. The main study trained clinicians and nursing staff in serious illness care conversations and requested they refer eligible patients. Eligible patients were those with serious illness or frailty expected to live 1 to 2 years. Clinicians indicated it was difficult to identify eligible patients. This study aimed to find better methods for increasing patient recruitment for the ACP study.MethodsResearch staff brainstormed and implemented strategies to increase patient referrals from clinicians. Participating offices used Epic for their medical record and the Gagne Index was used to generate a list of eligible patients in Epic SlicerDicer. When patients from the Epic SlicerDicer report appeared on the schedule, clinicians and nursing staff were notified that they might be eligible for ACP. Clinicians and nursing staff were asked to complete a survey identifying their perception of implemented strategies. A Wilcoxon signed-rank test was conducted to compare referral numbers before and after the Gagne Index/Epic SlicerDicer intervention.ResultsSeven clinicians referred patients prior to and 11 after the Gagne Index/Epic SlicerDicer intervention. Clinicians referred a total of 120 patients; 31 patients prior to and 89 patients after the Gagne Index/Epic SlicerDicer implementation (P = .002). Survey results indicated that several strategies facilitated clinician referrals, including patients identified as potentially appropriate on the schedule, quarterly meetings with researchers, and e-mails with a list of potentially eligible patients.ConclusionsNotifying clinical staff about potential study participants increased patient referrals in this ACP study. Research staff must have time, funding, and patience to support clinical staff who are expected to refer patients to studies.

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