Effect of an educational program on medical students’ conversations with patients about advance directives

Greenberg, Jerome; Doblin, Bruce H.; Shapiro, Daniel; L, Linn; Wenger, Neil S.

doi:10.1007/bf02598288

Cited by 15 publications

(21 citation statements)

References 6 publications

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“…The sample in each study varied from 16 to 278, with five [19, 20, 22, 24, 25] including more than 100 participants. Five studies were conducted in the US [17, 20, 22, 25, 26], two in Australia [19, 24], one in the UK [18], one in Canada [23] and one in Korea [21]. The majority of participants were nurses, physicians and medical students.…”

Section: Resultsmentioning

confidence: 99%

A systematic review of the effects of advance care planning facilitators training programs

Chan

et al. 2019

BMC Health Serv Res

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Background Advance care planning (ACP) is the process of ongoing communication among patients, family and health care professionals regarding what plans for future care are preferred in the event that patients become unable to make their own decisions. Clinicians play an important role in ACP as both initiators and decision coaches. However, lack of training for clinicians has frequently been reported as the reason for low involvement in ACP discussions - hence the present review evaluates the effectiveness of ACP training programs for healthcare professionals to guide the development of novel training programs for them in the future. Methods A literature search for intervention studies was conducted independently by two reviewers in July 2018. Participants included all healthcare professionals working with adult patients suffering from terminal illness. The primary outcomes were the professionals’ knowledge of and attitudes towards ACP, and self-perceived competence in ACP conversations. The Effective Public Health Practice Project appraisal tool was used to examine the quality of the studies included. Results A total of 4025 articles were identified, and ten eligible articles, covering 1081 participants, were included in the review. However, there is a lack of high quality randomized controlled trials of providing ACP training for nurses working in non-palliative care hospital settings. The overall quality of the intervention studies was moderate. All the studies included used instructional sessions in their interventions, while some contained group discussion, role-play and the use of advanced technology. The training programs increased the knowledge, attitudes towards shared decision-making, perceived communication skills, confidence, comfort and experiences concerned with discussing end-of-life (EOL) issues. Patient advocacy, job satisfaction and perceived level of adequate training for EOL care were improved. The use of ‘decision aids’ was rated as acceptable and clinically useful. Conclusions Training for healthcare professionals in ACP has positive effects on their knowledge, attitude and skills. The use of decision aids and advanced technology, instructional sessions with role play, training content focused on ACP communication skills and the needs and experience of patient in the ACP process, and a values-based ACP process are all those factors that made the ACP training programs effective.

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Section: Resultsmentioning

confidence: 99%

A systematic review of the effects of advance care planning facilitators training programs

Chan

et al. 2019

BMC Health Serv Res

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“… Pre-intervention Patient AD Document Green 2011 [ 34 ] RCT 60 56 Second year medical student in Penn State College of Medicine USA Students help patients create advance directives using a multimedia decision-aid which helps patients clarify their values, explain end-of-life conditions, help users choose and communicate with their surrogate decision makers and translate their wishes and goals. Students using Standard AD Patient Satisfaction with EoL and EoL Care planning Student Knowledge Greenberg 1993 [ 28 ] RCT 46 47 Medical Students beginning their clerkship USA The high-intervention received the same reading as low intervention group as well as a small group seminar on topics of historical development of advance directives, students' experiences with death and dying, contents of a durable power of attorney for health care (DPAHC). Students also viewed a videotape illustrating important aspects of discussing the DPAHC.…”

Section: Resultsmentioning

confidence: 99%

“…Ratings for the overall quality of evidence and effectiveness of the educational interventions can be seen in the GRADE summary of findings table (See Additional file 3 ). Self-Efficacy Eight studies (2 RCTs [ 28 , 29 ], 6 Observational [ 4 , 6 , 30 – 33 ]), including 522 participants found that EoL communication skills training was associated with improved self-efficacy compared to usual training (SMD 0.57; 95 % CI 0.40–0.75; p < 0.001; very low quality evidence ) . There was no evidence of heterogeneity ( I 2 = 0 %) (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…

Fig. 2 Effect of educational interventions on a self-efficacy b knowledge and c communication scores with standardized patient encounters Knowledge Four studies (2 RCTs [ 28 , 34 ] and 2 Observational [ 35 , 36 ]), including 290 participants, reported knowledge outcomes. EoL communication skills training was associated with an increase in knowledge scores compared to usual training (SMD 0.76; 95 % CI 0.40–1.12 p < 0.001, low quality evidence) with moderate heterogeneity ( I 2 = 47 %) (Fig.…”

Section: Resultsmentioning

confidence: 99%

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Educational interventions to train healthcare professionals in end-of-life communication: a systematic review and meta-analysis

Chung¹,

et al. 2016

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BackgroundPracticing healthcare professionals and graduates exiting training programs are often ill-equipped to facilitate important discussions about end-of-life care with patients and their families. We conducted a systematic review to evaluate the effectiveness of educational interventions aimed at providing healthcare professionals with training in end-of-life communication skills, compared to usual curriculum.MethodsWe searched MEDLINE, Embase, CINAHL, ERIC and the Cochrane Central Register of Controlled Trials from the date of inception to July 2014 for randomized control trials (RCT) and prospective observational studies of educational training interventions to train healthcare professionals in end-of-life communication skills. To be eligible, interventions had to provide communication skills training related to end-of-life decision making; other interventions (e.g. breaking bad news, providing palliation) were excluded. Our primary outcomes were self-efficacy, knowledge and end-of-life communication scores with standardized patient encounters. Sufficiently similar studies were pooled in a meta-analysis. The quality of evidence was assessed using GRADE.ResultsOf 5727 candidate articles, 20 studies (6 RCTs, 14 Observational) were included in this review. Compared to usual teaching, educational interventions to train healthcare professionals in end-of-life communication skills were associated with greater self-efficacy (8 studies, standardized mean difference [SMD] 0.57;95 % confidence interval [CI] 0.40–0.75; P < 0.001; very low quality evidence), more knowledge (4 studies, SMD 0.76;95 % CI 0.40–1.12; p < 0.001; low quality evidence), and improvements in communication scores (8 studies, SMD 0.69; 95 % CI 0.41–0.96; p < 0.001; very low quality evidence). There was insufficient evidence to determine whether these educational interventions affect patient-level outcomes.ConclusionVery low to low quality evidence suggests that end-of-life communication training may improve healthcare professionals’ self-efficacy, knowledge, and EoL communication scores compared to usual teaching. Further studies comparing two active educational interventions are recommended with a continued focus on contextually relevant high-level outcomes.Trial registrationPROSPERO CRD42014012913Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-016-0653-x) contains supplementary material, which is available to authorized users.

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“…Preliminary data suggest this model may be effective for teaching students the skills of palliative medicine. 26 ' 27 The course stresses to students the importance of physician-patient communication skills and introduces them to several key topics in palliative care. Lectures provide students with the basic facts needed to practice palliative care.…”

Section: Resultsmentioning

confidence: 99%

Using a Patient Perspective to Improve Palliative Education: Helping Patients Go into That Good Night

Buss

1999

Journal of Palliative Medicine

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T HE PUBLIC ATTENTION TO AND SUPPORT OF physi-Medical education needs to provide students cian-assisted suicide suggests that many are and residents with knowledge, experience, and not as afraid of dying as they are of how they die. perhaps most importantly, examples of excelDespite this, physicians consistently fail to meet lence in care for the dying. This task is most aptly the needs of dying patients. 1 " 3 Death is often pre-accomplished during clinical years of training ceded by significant, chronic illnesses, so most where students learn to apply factual knowledge people frequently encounter physicians in the fi-and develop clinical acumen by participating dinal months or years of their lives. These interac-rectly in patient care and by observing others protions provide physicians with numerous oppor-vide patient care. During the clinical years many tunities to educate patients about the natural students use faculty as examples for developing progression of their disease, prepare them for the clinical habits and setting clinical priorities. 5 Undevelopment or worsening of their symptoms, fortunately, palliative care receives sparse attenand even help patients anticipate the expected na-tion during these years and has relatively few f acture of their final decline and demise. Many ulty mentors. A palliative care course that spans physicians, however, fail to recognize or utilize the third and fourth years of medical school these encounters as opportunities 3 to help pa-would provide an alternative model of care for tients prepare for death and define the goals of the dying, heighten student awareness of dying medical care at the end of life.patients' needs, and encourage students to ad-A careful look at clinical training reveals that dress these needs with all patients. In order to medical education fails to define the physician's create such a course, one must first recognize the role in caring for the dying and creates an envi-numerous obstacles to teaching and learning palronment that discourages students and residents liative care in the current environment of physifrom addressing patients' palliative needs. Pal-cian training. liative medicine is defined as "the study andThe hospital, home to much of clinical training, management of patients with active, progressive, provides medical students with a distorted view far-advanced disease for whom the prognosis is of death. A majority of patients die in the hospilimited and the focus of care is the quality of tal, 6 -7 but patients rarely come to the hospital prelife." 4 Ideally physicians should strive to address pared to die. Unless a patient's chart is stamped the quality of life for all of their patients, regard-with bold documentation to the contrary (ie, less of how advanced or curable their illness may DNR/DNI orders), physicians assume that pabe. Physicians who fail to recognize and address tients desire treatment. Too often palliative opthe palliative needs of dying patients likely over-tions are not explored until after multiple atlook critical qu...

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Effect of an educational program on medical students’ conversations with patients about advance directives

Cited by 15 publications

References 6 publications

A systematic review of the effects of advance care planning facilitators training programs

A systematic review of the effects of advance care planning facilitators training programs

Educational interventions to train healthcare professionals in end-of-life communication: a systematic review and meta-analysis

Using a Patient Perspective to Improve Palliative Education: Helping Patients Go into That Good Night

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