Background: Advance care planning (ACP) is a critical component of end-of-life (EoL) care, yet infrequently taught in medical training. Objective: We designed a novel curriculum that affords third-year medical students (MS3s) the opportunity to practice EoL care discussions with a trained older adult in the patient's home. Design: Volunteers were instructed as trained patients (TPs) to evaluate MS3s interviewing and communication skills. The MS3s received a didactic lecture and supplemental material about ACP. Pairs of MS3s conducted ACP interviews with TPs who gave verbal and written feedback to students. Student evaluations included reflective essays and pre/postsurveys in ACP skills. Settings and Participants: A total of 223 US MS3s participated in the curriculum. Results: Qualitative analysis of reflective essays revealed 4 themes: (1) students' personal feelings, attitudes, and observations about conducting ACP interviews; (2) observations about the process of relationship building; (3) learning about and respecting patients' values and choices; and (4) the importance of practicing the ACP skills in medical school. Students' confidence in skills significantly improved in all 7 domains (P < .001): (1) introduce subject of EoL; (2) define advance directives; (3) assess values, goals, and priorities; (4) discuss prior experience with death; (5) assess expectations about treatment and hospitalization; (6) explain cardiopulmonary resuscitation and outcomes; and (7) deal with own feelings about EoL and providers' limitations. Conclusions: The use of older adults as TPs in an ACP curriculum provides students an opportunity to practice skills and receive feedback in the nonmedical setting, thereby improving comfort and confidence in approaching these conversations for future patients.
Background
African Americans in the general population have been shown to be less likely than White ethnic groups to participate in advance care planning; however, advance care planning in the population receiving dialysis has not been well explored.
Objective
We examined the prevalence of African American patients receiving haemodialysis' advance care planning discussions, and whether advance care planning impacts end‐of‐life care preferences.
Design
In‐person interviewer‐administered surveys of African American patients receiving in‐centre haemodialysis.
Setting/Participants
About 101 participants at three large dialysis organisation units in Chicago.
Outcomes
Self‐reported advance care planning and preferences for life‐extending treatments at end‐of‐life.
Results
Most patients (69%) report no advance care planning discussions with their healthcare providers. Nearly all patients (92%) without prior advance care planning reported their healthcare providers approached them about advance care planning. While the majority of patients indicated preference for aggressive life‐extending care, prior conversations about end‐of‐life care wishes either with family members or a healthcare provider significantly decreased patients' likelihood of choosing aggressive life‐extending care across three scenarios (all p < 0.05). Significantly more patients reported that common end‐of‐life scenarios related to increased dependence/disability were “not worth living through” compared with those associated with increased burden on family, decreased cognitive function, and severe pain/discomfort.
Conclusion
African Americans with end‐stage renal disease need more frequent, culturally‐sensitive advance care planning discussions. Despite a preference for aggressive life‐sustaining treatments, individuals with prior advance care planning discussions were significantly less likely to support aggressive end‐of‐life care. End‐of‐life care discussions that focus on the impact of life‐extending care on patients' independence could be more concordant with the values and priorities of the African American patients.
Identify circumstances or constructs that may be challenging for patients to reflect on within a specified time period. Describe the complexity of item wording to assess critical care components in the context of palliative care. Original Research Background. In partnership with AAHPM and the National Coalition for Hospice and Palliative Care, RAND Health is testing measurement items for a short survey about the care patients receive from their palliative care doctors, nurses, and other team members. Survey questions focus on concepts related to communication (e.g., feeling heard and understood) and symptom management (e.g., receiving help wanted for pain). Research Objectives. The interviews were designed to assess comprehensibility, ambiguity, and adaptability to context-specific circumstances for patients and caregivers as well as gather suggestions for language refinement for both symptom and communication measure concepts.
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