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

Novel approach to advance directive training: Hospice and palliative care fellow led workshop feasible and effective in increasing confidence in end of life conversations

Despite the benefits of Advance directives, approximately only 1 in 3 U.S adults have documented advance directives. In medical school and residency, learners are often not taught or given very brief information on conducting end-of-life planning conversations with patients. Due to this deficiency, some institutions have conducted advance directive workshops but not many have been both palliative fellow and resident led, though some have been led by a geriatric fellow. Therefore, we approached advance directives with a resident and palliative fellow-led workshop. We aimed to develop and conduct a workshop on advance directives to assess feasibility and effectiveness in raising resident confidence in discussing advance directives. We sent a survey to 52 residents prior to two one-hour didactic sessions. For the first session, a small group of residents discussed common terminology and the tools available to help patients complete advanced directives in the outpatient setting. A hospice and palliative care fellow led the second session and focused on patient communication and approach. Our results showed that the workshop was well-received and improved resident confidence in discussing advance directives with patients. In conclusion, a resident and palliative fellow-led advance directive workshop for internal medicine residents was feasible and effective in increasing resident confidence.

Determining the Effects of Complex Education on Primary Care Nurse Practitioners' Self-efficacy in Advance Care Planning for Healthy Adults

Advance care planning is a process in which capable adults communicate their preferences for medical care in case of incapacitation. Regardless of health status, most adults are interested in advance care planning conversations and prefer providers to initiate these discussions. Primary care nurse practitioners are ideally positioned to lead these conversations but lack knowledge, confidence, and communication skills to do so. This project aimed to develop, implement, and evaluate an educational program for primary care nurse practitioners regarding leading advance care planning conversations with healthy adults. This evidence-based practice project used the Advance Care Planning Self-Efficacy Scale to measure primary care nurse practitioners' self-efficacy after completing a complex educational program. The educational program was developed based on a nationally recognized program incorporating didactic, observational, and role-play learning. The findings of this project indicated that providing complex education was an effective intervention immediately and after 3 months ( P = .018 and P = .023, respectively). The results indicate that educating nurse practitioners is an effective intervention for increasing their self-efficacy in leading advance care planning conversations with healthy adults over 3 months, recommending additional intervention at least earlier than 6 months.

Developing an innovative national ACP-OSCE program in Taiwan: a mixed method study

OBJECTIVES

To evaluate the process and the comprehensiveness of advance care planning (ACP), we designed a national ACP-OSCE (Objective Structured Clinical Examination) program.

METHODS

The program was designed as a 40-minute OSCE test. Participants were categorized as different ACP team members to illustrate realistic scenarios. Preceptors were asked to observe ACP professionals' actions, responses, and communication skills during ACP with standardized patients (SP) through a one-way mirror. Participants' communication skills, medical expertise, legal knowledge, empathetic response and problem-solving skills of ACP were also self-evaluated before and after OSCE. Thematic analysis was used for qualitative analysis.

RESULTS

In Nov 2019, a total of 18 ACP teams with 38 ACP professionals completed the ACP-OSCE program, including 15 physicians, 15 nurses, 5 social workers, and 3 psychologists. After the ACP-OSCE program, the average score of communication skills, medical expertise, legal knowledge, empathetic response, ACP problem-solving all increased. Nurses felt improved in medical expertise, legal knowledge, and problem-solving skills, psychologists and social workers felt improved in legal knowledge, while physicians felt no improved in all domain, statistically. Thematic analysis showed professional skills, doctoral-patient communication, benefit and difficulties of ACP were the topics which participants care about. Meanwhile, most participants agreed that ACP-OSCE program is an appropriate educational tool.

CONCLUSION

This is the first national ACP-OSCE program in Asia. We believe that this ACP-OSCE program could be applied in other countries to improve the ACP process and quality.

Quantitative Evaluation of Dental Students' Perceptions of the Roleplay-Video Teaching Modality in Clinical Courses of Dentistry: A Pilot Study

In the modern era of dentistry, role modeling/roleplaying is one of the most prevalent and recommended methods of dental education. Working on video production projects and using student-centred learning also help students create feelings of ownership and self-esteem. This study aimed to compare students' perceptions of roleplay videos among genders, different disciplines of dentistry, and different levels of dental students. This study included 180 third- and fourth-year dental students registered in courses such as 'Introduction to Dental Practice' and 'Surgical management of oral and maxillofacial diseases', respectively, at the College of Dentistry at Jouf University. Four groups of recruited participants were pre-tested using a questionnaire about their clinical and communication skills. The students were tested again using the same questionnaire at the end of the workshop to evaluate improvements in their skills. The students were then assigned to create roleplay videos with respect to demonstrated skills related to all three disciplines (Periodontics, Oral Surgery, and Oral Radiology) in a week's time. Students' perceptions of the roleplay video assignments were collected through a questionnaire survey. The Kruskal-Wallis test was used to compare responses for each section of the questionnaire (p < 0.05). Improvements in problem-solving and project management skills during video production were reported by 90% of the participants. No significant difference (p > 0.05) in the mean scores of the responses was found with respect to the type of discipline involved in the process. There was a significant difference in the mean scores of the responses between male and female students (p < 0.05). The fourth year participants demonstrated increased mean scores and significantly higher (p < 0.05) mean scores than third-year participants. Students' perceptions of roleplay videos differed by gender and the level of the students, but not by the type of discipline.

Short and medium-term effects of different teaching strategies for interprofessional education in health professional students: A randomized controlled trial

BACKGROUND

Interprofessional education (IPE) is recognized as important for teaching in healthcare. However, few studies comparing active versus traditional strategies for this teaching approach have been conducted.

OBJECTIVES

This study aims to compare the use of different educational strategies (i.e. active learning versus formal lectures) for teaching interprofessional geriatric competencies in health professional students from different healthcare courses.

DESIGN

Randomized controlled trial.

SETTINGS

Public university.

PARTICIPANTS

Health professional students (nursing, physiotherapy, medicine, nutrition and psychology courses).

METHODS

Different theoretical educational strategies (active learning in intervention group versus formal lectures in control group) were associated with case-based group discussions. The RIPLS (Readiness for Interprofessional Learning Scale), IEPS (Interdisciplinary Education Perception Scale) and TSS (Team Skills Scale) instruments were applied at 3 timepoints: on first day of class, on last day of class and at 6 months post-intervention.

RESULTS

Of 151 eligible students, 99 concluded all stages of the study and were subsequently included in the analysis. A significant increase in scores on the RIPLS, IEPS and TSS was measured on the last day of class and this performance gain persisted after 6 months for both strategies. However, no significant performance difference between the two strategies was found. Similarly, although student satisfaction was very good, no difference in ratings between the strategies was evident.

CONCLUSIONS

The results of this project, besides developing and fostering important discussion on IPE, can add to the literature and aid researchers in IPE by furthering knowledge on how different teaching strategies can impact future health professionals.

Junior Medical Officers' knowledge of advance care directives and substitute decision making for people without decision making capacity: a cross sectional survey

Background

For the benefits of advance care planning to be realised during a hospital admission, the treating team must have accurate knowledge of the law pertaining to implementation of advance care directives (ACDs) and substitute decision making.

Aims

To determine in a sample of Junior Medical Officers (JMOs): (1) knowledge of the correct order to approach people as substitute decision makers if a patient does not have capacity to consent to treatment; (2) knowledge of the legal validity of ACDs when making healthcare decisions for persons without capacity to consent to treatment, including the characteristics associated with higher knowledge; and (3) barriers to enacting ACDs.

Methods

A cross-sectional survey was conducted at five public hospitals in New South Wales, Australia. Interns, residents, registrars, and trainees on clinical rotation during the recruitment period were eligible to participate. Consenting participants completed an anonymous pen-and-paper survey.

Results

A total of 118 JMOs completed a survey (36% return rate). Fifty-five percent of participants were female and 56.8% were aged 20–29 years. Seventy-five percent of JMOs correctly identified a Guardian as the first person to approach if a patient did not have decision-making capacity, and 74% correctly identified a person’s spouse or partner as the next person to approach. Only 16.5% identified all four persons in the correct order, and 13.5% did not identify any in the correct order. The mean number of correct responses to the questions assessing knowledge of the legal validity of ACDs was 2.6 (SD = 1.1) out of a possible score of 6. Only 28 participants (23.7%) correctly answered four or more knowledge statements correctly. None of the explored variables were significantly associated with higher knowledge of the legal validity of ACDs. Uncertainty about the currency of ACDs and uncertainty about the legal implications of relying on an ACD when a patient’s family or substitute decision maker disagree with it were the main barriers to enacting ACDs.

Conclusion

JMOs knowledge of the legal validity of ACDs for persons without decision making capacity and the substitute decision making hierarchy is limited. There is a clear need for targeted education and training to improve knowledge in this area for this cohort.

Facilitating the Advance Care Planning Conversation with Patients: An Interactive Virtual 1.5-Hour Session

OBJECTIVES

The Liaison Committee on Medical Education requires that the curriculum of medical schools includes end-of-life care. Most medical students feel reluctant to discuss end-of-life issues with their patients, but would like to learn more.

METHODS

We created an educational session on using Five Wishes to facilitate the advance care planning conversation. Third- and fourth-year students were given a brief PowerPoint lecture detailing the importance of advance directives, barriers to advance care planning conversations, approaches for the conversation, and two brief video sample conversations. Students discussed their experiences related to advance directives and role-played a part of an advance care planning conversation.

RESULTS

A total of 97 medical students participated in the didactic on advance care planning conversations from May 4, 2020 to October 24, 2020. Eighty-six (88.7%) of 97 students responded to the postcourse evaluation survey. Most of the respondents (96%) agreed or strongly agreed that the session was pertinent to learning needs and that the goals and objectives of the session were met. Ninety-two percent of respondents felt confident about having a conversation with a patient about advance directives and 88% of respondents felt comfortable starting and completing advance directives conversations.

CONCLUSIONS

The brief didactic presented here on facilitating advance directives conversations constitutes an easily implemented and well-received session for medical students. Students reported high levels of confidence and comfort around having advance directive conversations after participating in this didactic session.

Roleplay as an Educational Strategy in Palliative Care: A Systematic Integrative Review

INTRODUCTION

Simulation activities, such as roleplay, have become established in undergraduate and graduate education in several subjects of healthcare. The objective of this study was to synthesize the evidence available in the literature on the use of roleplay as an educational strategy in palliative care.

METHODS

Using the method proposed by Whittemore and Knafl, this integrative systematic review was carried out based on the following guiding question: "What is the available evidence in the literature on the use of roleplay as an educational strategy in the teaching of palliative care?" The databases used for the selection of articles were the following: Web of Science, Scopus, Cochrane Library, PubMed, CINAHL, EMBASE, and LILACS. There were no limitations regarding the year of publication or language.

RESULTS

The articles (n = 34) were grouped into 3 categories, according to the purpose of roleplay use: 1) Use of roleplay as an educational strategy to teach communication in palliative care; 2) Use of roleplay as an educational strategy to teach the communication of bad news, and 3) Use of roleplay as an educational strategy to teach end-of-life care.

CONCLUSION

Roleplay has been employed in the teaching of palliative care in order to develop skills related to communication and to the provision of end-of-life care. These educational activities have mainly been directed to healthcare students and professionals. Future investigations should further evaluate the efficacy of this teaching strategy, based on studies with more robust designs that allow the establishment of cause-and-effect relationships.

Implementation of advance care planning amid the COVID-19 crisis: A narrative review and synthesis

Advance care planning is considered an important issue in end‐of‐life care for older adults. The ongoing COVID‐19 pandemic has interrupted the healthcare system and end‐of‐life care tremendously. This review aimed to explore available articles on advance care planning amid the pandemic and analyze qualitatively. PubMed and Google Scholar were searched on February 2021 using the relevant keywords. Retrieved articles were screened applying inclusion criteria. Any article describing advance care planning during the COVID‐19 era was included. A qualitative content analysis was conducted. In total, 20 articles incorporating 5542 participants from five countries were included. Among the articles, eight were primary studies and the rest were perspective papers or secondary analysis. From the qualitative content analysis six major themes emerged namely palliative care, lack of coordination among acute care, hospital palliative care, and long‐term care, community‐based advance care planning, real‐time dissemination of scientific information on the regional pandemic situation, online system and legislation. The COVID‐19 pandemic had decreased the uptake of advance care planning. Findings of the review suggested simplification of the procedure regarding advance care planning, implementation of community‐based advance care planning and utilization of online resources to enhance the process. Geriatr Gerontol Int 2021; 21: 779–787.

Human Papillomavirus Knowledge and Communication Skills: A Role-Play Activity for Providers

INTRODUCTION

Human papillomavirus (HPV) infection and related cancers are a major cause of morbidity and mortality worldwide. Routine vaccination against HPV is recommended for patients starting at age 9-12 years. Discussing this vaccine with parents of young children can be challenging for clinicians. Barriers include parental beliefs, strength and quality of clinician recommendations, physician knowledge of HPV disease and vaccines, and provider comfort levels with discussing sexuality.

METHODS

Our interactive workshop began with a predidactic role-play session addressing common concerns about the HPV vaccine where participants took turns playing a concerned parent or provider. We then gave a 30-minute didactic lecture and conducted a postdidactic role-play session to practice communication skills in promoting the HPV vaccine. All participants completed pre- and postintervention knowledge and skill self-assessments.

RESULTS

Twenty-eight pediatric residents and medical students participated. We observed significant improvement in their ability to appropriately recommend the HPV vaccine in the postdidactic role-play (all ps < .02). Learner knowledge improved from pre- to postintervention (from 34% to 100%, p < .0025, based on average score), as did self-perceived comfort and confidence levels (from 3.6 to 4.3, p < .0001, average score based on a 5-point Likert scale).

DISCUSSION

An interactive workshop utilizing role-play supplemented by a didactic lecture was effective in improving participants' knowledge, communication skills, comfort levels, and confidence levels regarding HPV disease and vaccines. The workshop offers a practical and interpersonal approach to improving learners' skills in discussing the HPV vaccine with parents.