Innovative Training Program in Advance Care Planning

Abstract

Background: Advance care planning (ACP) is a key component in achieving high quality care for patients approaching the end of life. Clinician factors, such as self-doubt and fear of taking away hope, are among the most significant barriers to carrying out successful ACP discussions in current clinical practice. These barriers may be related to inadequate training in end of life communication and care at all levels of medical education. These training deficits have been shown to exist even within the field of oncology, where the need for proper ACP is especially high. Here we describe a training program for oncology clinicians at the Dana-Farber Cancer Institute (DFCI), designed based on the methods known to be most effective in adult continuous professional development. Methods: As part of the larger Serious Illness Care Project at DFCI, 52 oncology clinicians attended a 2.5 hour training session in ACP and communication skills led by 1-2 experienced palliative care educators. Training sessions were composed of three main parts: cognitive input (interactive lecture with review of current status of end-of-life care and a structured approach for carrying out ACP discussions); modeling (demonstration of an ACP discussion between faculty and standardized patient); and practice of key skills (observed role-play exercise between clinicians and standardized patient with feedback). Before and immediately after the session, all clinicians completed surveys regarding their attitudes towards ACP and their confidence in skills related to ACP/communication. Clinicians also completed an anonymous training evaluation form. Results: The mean rating of the session was 4.38/5, accompanied by positive open text feedback. Clinicians felt the most effective aspects of the session were the demonstration and role-play exercise. There were no statistically significant changes in confidence or attitudes following the intervention based on self-rated surveys. On anonymous evaluation forms, 90.2% of clinicians reported that they felt the session enhanced their confidence in talking to patients and 92.2% felt it improved their skill in conduction discussions about end-of-life care. 98% of clinicians carried out at least one conversation within their clinical practice following the session. Conclusions: Our results suggest that this model of training might be a means to promoting a needed change in ACP practices within the field of oncology, in a manner that is both time-effective and acceptable to clinicians.