Efficacy of an Online Curriculum for Perioperative Goals of Care and Code Status Discussions: A Randomized Controlled Trial

Robertson, Amy; Fowler, Leslie C; Kimball, Thomas S; Niconchuk, Jonathan A; Kreger, Michael; Brovman, Ethan Y.; Rickerson, Elizabeth; Sadovnikoff, Nicholas; Hepner, David L.; McEvoy, Matthew D.; Bader, Angela M.; Urman, Richard D.

doi:10.1213/ane.0000000000005548

Cited by 10 publications

(26 citation statements)

References 37 publications

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“…Four studies only assessed change in attitudes, 25,28–30 and one study only assessed change in knowledge 26 about topics discussed by the intervention. Four studies assessed both changes in knowledge and attitudes about information provided in the intervention.…”

Section: Resultsmentioning

confidence: 99%

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Digital Educational Interventions for the Development of Advanced Care Planning Skills for Medical Practitioners: A Scoping Review

Shah

Janssen

Donnelly

et al. 2022

J Contin Educ Health Prof

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Background: Medical practitioners are important facilitators of advanced care planning but are often reluctant to engage in these conversations with patients and their families. Barriers to participation can be addressed through medical education for medical practitioners. Introduction: The primary objective was to examine the extent to which digital educational interventions are used to foster advanced care planning skills. Secondary objectives include understanding the acceptability of these interventions and whether electronic health records can be used to personalize learning. Methods: Online databases were used to identify relevant articles published from 2008 to 2021. Nine articles which evaluated the impact of digital learning for medical practitioners were selected. Studies eligible for inclusion in the review assessed changes in knowledge, attitudes, and practice regarding skills used in advanced care planning. Results: All publications used a pre-post study design with education delivered solely online. Only three studies focused on completing advance care plans or directives (33%). All but two studies recorded improvements in knowledge and/or attitudes toward planning (78%) while three studies recorded improvements in clinical practice (33%). The review suggests prior clinical or personal experiences could be used to personalize education. Discussion: The literature revealed that using digital education to develop advanced care planning skills is relatively unexplored despite the ability of this type of learning to improve professional knowledge and confidence. Digital devices can also improve access to relevant information at the point-of-care. Personalized interventions that incorporate prior clinical experiences, potentially extracted from health records, could be used to optimize outcomes.

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Section: Resultsmentioning

confidence: 99%

“…22–24,27 Three studies assessed change in real-life practice using an e-simulation 24 or a standardized patient. 28,29…”

Section: Resultsmentioning

confidence: 99%

Digital Educational Interventions for the Development of Advanced Care Planning Skills for Medical Practitioners: A Scoping Review

Shah

Janssen

Donnelly

et al. 2022

J Contin Educ Health Prof

View full text Add to dashboard Cite

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“…from palliative to curative), potentially leading to inappropriate treatment escalation intraoperatively and postoperatively. 30…”

Section: Misconceptions About the Goc Framework In The Perioperative ...mentioning

confidence: 99%

“…from palliative to curative), potentially leading to inappropriate treatment escalation intraoperatively and postoperatively. 30 The final misconception ignores the need to ensure that a patient's wishes and survival during surgery are transparently balanced. Survival is an important patient-centred outcome, even for those in the palliative phase.…”

Section: Misconceptions About the Goc Framework In The Perioperative ...mentioning

confidence: 99%

The goals of care framework and the perioperative period: A practical approach

Lee

Ashby

2023

Anaesth Intensive Care

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The goals of care (GOC) framework (2014) is an illness phase categorisation system that enables limitations of medical treatment (LOMT) to be documented and communicated within a healthcare system. It incorporates a clinical assessment of illness phase and GOC discussion on aims and LOMT for an episode of care. Together, this results in documentation of a GOC category that guides treatment escalation decisions during episodes of patient deterioration. Confusion exists about incorporating this framework into the perioperative period, particularly management of treatment escalation required for patient survival during surgery that is at variance with agreed goals and limitations. A historical tendency for automatic and unilateral suspension of limitations during surgery may be susceptible to ethical or medicolegal challenge. This article highlights the difference between the GOC framework and ‘not for resuscitation’ framework, considers the unique considerations of the perioperative period and addresses misconceptions of the GOC framework in patients undergoing surgery. Finally, it provides an approach to the GOC framework for patients considered for surgery by emphasising illness phase assessment and the need for the GOC category to accurately reflect the clinical situation throughout the perioperative period, guiding treatment escalation intraoperatively and postoperatively.

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“…Shared decision-making is a form of communication that prioritizes the patient's goals and preferences in dialogues regarding risks, benefits and alternatives of a proposed treatment plan. Shared decision-making as it relates to goals of care (GOC), code status , and informed consent during the perioperative period is critical to providing high quality, patient-centered care [16 ▪ ]. Historically, these conversations have centered around do not resuscitate/do not intubate status and reversal of code status for the duration of the perioperative period.…”

Section: Shared Decision-makingmentioning

confidence: 99%

Addressing comorbidities in the perioperative setting and optimizing perioperative medicine education

Krishnan

Adeola

Urman

2022

Current Opinion in Anaesthesiology

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Purpose of reviewPreoperative clinics and patient optimization are examples of collaborative, multidisciplinary care pathways that create value. This article reviews current literature to demonstrate the importance of preoperative enhancement of patients’ cognitive and functional status. This article underscores the importance of formal training in multidisciplinary topics, such as frailty, brain health, and shared decision-making for anesthesiology house staff.Recent findingsPreoperative cognitive screening of older patients is a valuable metric for risk stratification and detection of patients at risk of postoperative delirium. Frailty is another syndrome that can be identified and optimized preoperatively. Sarcopenia has been shown to correlate with frailty; this shows promise as a method to detect frailty preoperatively.SummaryAnesthesiologists as perioperative physicians are in a unique position to lead and coordinate interdisciplinary conversations that incorporate patient goal concordant care and realistic assessment of perioperative complications. Formal house staff training in early recognition and management of patients at risk of adverse outcomes in the short and long term postoperatively improves patient outcomes and decreases healthcare spending.

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Efficacy of an Online Curriculum for Perioperative Goals of Care and Code Status Discussions: A Randomized Controlled Trial

Cited by 10 publications

References 37 publications

Digital Educational Interventions for the Development of Advanced Care Planning Skills for Medical Practitioners: A Scoping Review

Digital Educational Interventions for the Development of Advanced Care Planning Skills for Medical Practitioners: A Scoping Review

The goals of care framework and the perioperative period: A practical approach

Addressing comorbidities in the perioperative setting and optimizing perioperative medicine education

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