Background Acute hospital clinicians play a key role in initiating discussions around advance care planning (ACP). Despite a widespread agreement that ACP is beneficial and facilitates patient-centred decision making, ACP prevalence in the acute hospital setting can be sporadic. COVID-19 created a heightened awareness of the need for early decision-making, in order to ensure patients received appropriate treatments, based on their general health, personal values and individual wishes. Methods A retrospective study of patients admitted to a tertiary UK hospital Cardiology department during two discrete time periods; December 2019 and April 2020. Data was collected from electronic records and compared for significant differences between groups. This included the completion of ReSPECT forms, age, co-morbidities, frailty score and discharge diagnosis. Results The study included 164 patients in total. There was no significant difference in age, co-morbidities or frailty between the groups. ReSPECT form completion significantly increased from December 2019 to April 2020 (9/84 (11%) vs 39/80 (49%); p < 0.0001). 25/26 (94%) of COVID-19 positive patients had evidence of ReSPECT form discussion. For individuals with non-COVID-19 diagnoses, 14/54 (26%) had evidence of ReSPECT form discussions. Conclusions There was a statistically significant improvement in ACP during the first wave of COVID-19. Factors influencing this are likely to include heightened public and professional awareness of healthcare resources, an acknowledgement for rapid deterioration in patients with COVID-19, increased media coverage around the necessity for early decision-making, and a subsequent increase in patient expectation to discuss ACP. COVID-19 provides the opportunity to better establish meaningful ACP into acute hospital practice in the future. Further work is needed to assess the quality of the ACP process and individual patient experience. Increased familiarity with ACP, at both a public and professional level, could lead to enduring improvements in the facilitation of conversations and patient-centred decisions.
Evidence demonstrates that medical students have limited experience in developing ‘higher-order communication skills’ (Kaufman et al. 2000). Anecdotally many do not feel confident in their ability to conduct difficult conversations often due to a lack of exposure to such scenarios in practice or a pervasive notion that these scenarios are inappropriate for students and beyond the scope of a junior doctor’s role and thus not a focus of curriculums (Noble et al. 2007). There is however a correlation between level of clinical experience and improved confidence for medical students (Morgan and Cleave-Hogg 2002).We surveyed a group of final year medical students to assess their confidence using a 10-point Likert scale in tackling common palliative and end of life care scenarios. Our intervention comprised a study day of 10 practical small-group teaching simulation and OSCE-style stations designed to provide exposure to common experiences in a controlled setting. We reassessed the confidence of students after delivery and objectively explored the impact of the day by asking participants to complete a validated assessment before and after the course. All results showed significant improvement on t-testing: confidence in end of life communication in an OSCE setting improved by 42.2% and assessment marks improved by 24.7% (p=0.039).Palliative care is an area in which students approaching the end of undergraduate training feel underprepared. Our findings demonstrate that small group sessions improve confidence by facilitating communication practice in a controlled environment and providing crucial exposure to common palliative care scenarios they will face as doctors.References. Kaufman D, Laidlaw T, Macleod H. Communication skills in medical school: Exposure confidence and performance. Academic Medicine [online] 2000;75(10):S90–S92. Available at https://journals.lww.com/academicmedicine/Fulltext/2000/10001/Communication_Skills_in_Medical_School__Exposure.29.aspx [Accessed: 30 May 2018]. Morgan P, Cleave-Hogg D. Comparison between medical students’ experience confidence and competence. Medical Education [online] 2002;36(6):534–539. Available at https://doi.org/10.1046/j.1365-2923.2002.01228.x [Accessed: 30 May 2018]. Noble L, Kubacki A, Martin J, Lloyd M. The effect of professional skills training on patient-centredness and confidence in communicating with patients. Medical Education [online] 2007;41(5):432–440. Available at https://doi.org/10.1111/j.1365-2929.2007.02704.x [Accessed: 30 May 2018]
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