Evaluation of Novel Multimedia Education to Train Doctors to Discuss Advance Care Planning (ACP) Karen Detering [email protected] William Silvester, Charlie Corke, Sharon Milnes Background. • ACP improves outcomes for patients and their families • Many patients do not have access to quality ACP • Many doctors lack the confidence to have ACP conversations with their patients • Communication skills can be learned, and once learned they can be retained • To try and improve access to ACP we developed an interactive educational program “The next steps” Aim: • To develop and then pilot an interactive ACP training program for doctors • Especially aimed at GPs and doctors in training • Doctors worked in urban and rural settings The “next steps program” • Included • E-simulation • DVD • Interactive workshop • Training manual • 4 steps of Advance Care Planning. • • • • Introduce the topic Explore concepts – pt illness, wishes Introduce solutions Summarise the conversation. E-Simulation Questions: There is something I need to talk to you about. It's about planning for future medical treatment. Is it all right to talk to you about this now? Do you mind if we spend a few minutes now talking about your overall health? I would like to bring up something else. It's thinking about the sort of medical treatment that you don't want as you near death. It is important that you think about this and communicate your wishes. This will help us make the right choices for you. Because of your age and medical condition, it wouldn't surprise me if you were to die during the next 12 months - so there is a process I think you should go through that plans for medical treatment toward the end of life. Transcript: Research shows that patients expect their doctor to initiate this conversation. It is good to check with the patient if it is okay to proceed with this discussion.[1-4] (+10) E-Simulation Questions: This process is called advance care planning and it lets you plan in advance for your future medical care. Is something that you would want to do? If you become critically ill, there are treatments you might not want. You need to tell me what those would be There is a process that considers how you want to die. It's for people who are near the end of their lives. Can I start by asking you how you feel about your health at the moment? Transcript Referring to critically ill is something that the patient will either not understand or will scare them off and they will disengage. During early discussions, focus should stay on living well and goals of care rather than medical treatments [4-6]. (-10) E-Simulation • Participants can go through it as often as they wish • Each run through takes up to 25-30 minutes • At the end of each” run through” a transcript and score is given • Maximum score is 80 DVD • Scenarios • Doctors in acute care • Doctors in primary care • Follow up conversation • Completing documents Scenario 1 Scenario 2 Interactive workshop: • Review of participants’ experience / knowledge of ACP • Demonstration of ACP undertaken by GPs and hospital-based doctors, using scenarios on the DVD • Role plays by participants of an advance care planning conversation. • Facilitated discussion. • Runs for 90-120 minutes Next steps pilot and evaluation: • Doctors were recruited to participate in “next steps” via local doctor training organisations • Participants completed pre and post training surveys • Demographics (pre survey only) • Questions on ACP knowledge, attitudes to ACP, confidence to discuss ACP • E- Simulation score • Participants also rated the educational tools Demographics (148 attended workshop) • 51% male, 72 % < 41 years age (21-65) • 62% trained outside Australia • Workplace setting • General practice – 44% • Hospital – 43% • Both GP and hospital – 13% ACP Knowledge (8 questions) • Questions relating to both ACP, and legal aspects of ACP • Pre-education scores were high (5.9 / 8) • Post-education significant improvement in scores – 6.7 / 8 (p,0.05) Attitudes to ACP (10 questions) • Doctors were asked to respond to statements related to ACP and indicate how strongly they agree or disagree • All 10 statements – some change in attitude, but only 2 showed statistically significant change: “Most of the time family members know the person’s preference regarding EOL care” “Helping patients complete an Advance Care Plan is emotionally draining” Confidence to discuss ACP (8 statements) • Doctors responded to statements related to perceived confidence with ACP skills and indicate how confident or unconfident they felt. • 6 statements had statistically significant improvements following training E-Simulation (max score = 80) • Following training there was a significant improvement in score (pre =18, post=53, p<0.05) • Used E-simulation on average 3 times • Used on average 17 minutes per time Conclusion • The next steps training program: • Well received • Improved knowledge, attitudes and confidence regarding ACP • Important educational tool to facilitate development of doctor ACP conversation skills and thus improve patient access quality ACP • The “next steps” tools are now available Victorian Quality Council Website www.health.vic.gov.au/qualitycouncil/activities/training
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