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Pearse W, Saxon R, Plowman G, Hyde M, Oprescu F. Continuing Education Outcomes for Advance Care Planning: A Systematic Review of the Literature. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2021; 41:39-58. [PMID: 33433128 DOI: 10.1097/ceh.0000000000000323] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Advance care planning (ACP) is a process of considering future health and care needs for a time when a person may be unable to speak for themselves. Health professional continuing education programs have been proposed for facilitating patient participation in ACP; however, their impacts on participants, patient and clinical outcomes, and organizational approaches to ACP are not well understood. METHODS This systematic literature review examined interventional studies of education programs conducted with health professionals and care staff across a broad range of settings. Five electronic databases were searched up to June 2020, and a manual search of reference lists was conducted. The quality of studies was appraised by the first, second, and third authors. RESULTS Of the 7993 articles identified, 45 articles met the inclusion criteria. Program participants were predominantly medical, nursing, and social work staff, and students. Interventions were reported to improve participants' self-perceived confidence, knowledge, and skills; however, objectively measured improvements were limited. Multimodal programs that combined initial didactic teaching and role-play simulation tasks with additional activities were most effective in producing increased ACP activity in medical records. Evidence for improved clinical outcomes was limited. DISCUSSION Further studies that use rigorous methodological approaches would provide further evidence about what produces improved patient and clinical outcomes. Needs analyses and quality indicators could be considered to determine the most appropriate and effective education resources and monitor their impacts. The potential contribution of a broader range of health professionals and interprofessional learning approaches could be considered to ultimately improve patient care.
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Affiliation(s)
- Wendy Pearse
- Ms. Pearse: End of Life Care Project Manager, Nambour General Hospital, Sunshine Coast Hospital and Health Service, Queensland, Australia, and School of Health and Sports Sciences, University of the Sunshine Coast, Queensland, Australia. Dr. Saxon: Allied Health Data and Informatics, Advanced Speech Pathologist, Sunshine Coast University Hospital, Sunshine Coast Hospital and Health Service, Queensland, Australia. Dr. Plowman: Physician, Sunshine Coast University Hospital, Sunshine Coast Hospital and Health Service, Queensland, Australia. Dr. Hyde: Professor, School of Education, University of the Sunshine Coast, Queensland, Australia. Dr. Oprescu: Associate Professor, School of Health and Sport Sciences, University of the Sunshine Coast, Queensland, Australia
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Donne J, Odrowaz T, Pike S, Youl B, Lo K. Teaching Palliative Care to Health Professional Students: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Am J Hosp Palliat Care 2019; 36:1026-1041. [DOI: 10.1177/1049909119859521] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background:End-of-life care is challenging on health professionals’ mental and emotional state. Palliative care education can support health professional students’ transition, helping them to cope with the challenges of working in this complex setting. Students feel that they need more preparation in this area.Purpose:To collate the relevant information regarding how to teach health professional students about palliative care.Method:The full holdings of Medline, PsycINFO, EBM Reviews, Cinahl Plus, ERIC, and EMBASE via Elsevier were searched until April 7, 2019. Inclusion criteria were randomized controlled trials of group interventions that aimed to increase health professional students’ knowledge, skills, or attitudes in palliative care. Studies were appraised using the PEDro scale. Data were synthesized using meta-analysis.Results:The results favored the intervention and were statistically significant for knowledge and attitudes but not for skills. A 2-hour seminar accompanied by readings seems sufficient to improve both knowledge and attitudes. Quality assessment scores ranged from 1/10 to 7/10 (mean 5, standard deviation 1.73). When studies at high risk of bias were excluded, then only knowledge improved significantly. Key areas where rigor was lacking were in concealing the randomization, omitting intention-to-treat analysis and not blinding of participants, therapists, or assessors.Conclusions:Palliative care education is effective in improving health professional students’ knowledge and attitudes toward palliative care. More research is required into skill development. This review highlights the need for more high-quality trials in both the short and long-term to determine the most effective mode of palliative care education.
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Affiliation(s)
- Jack Donne
- Department of Physiotherapy, Monash University, Melbourne, Australia
| | - Thomas Odrowaz
- Department of Physiotherapy, Monash University, Melbourne, Australia
| | - Sarah Pike
- Department of Physiotherapy, Monash University, Melbourne, Australia
| | - Bonnie Youl
- Department of Physiotherapy, Monash University, Melbourne, Australia
| | - Kristin Lo
- Department of Physiotherapy, Monash University, Melbourne, Australia
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Chan CWH, Ng NHY, Chan HYL, Wong MMH, Chow KM. A systematic review of the effects of advance care planning facilitators training programs. BMC Health Serv Res 2019; 19:362. [PMID: 31174530 PMCID: PMC6555972 DOI: 10.1186/s12913-019-4192-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 05/28/2019] [Indexed: 11/10/2022] Open
Abstract
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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Affiliation(s)
- Carmen Wing Han Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, 6/F, Esther Lee Building, Shatin, NT, Hong Kong
| | - Nancy Hiu Yim Ng
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, 6/F, Esther Lee Building, Shatin, NT, Hong Kong.
| | - Helen Y L Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, 6/F, Esther Lee Building, Shatin, NT, Hong Kong
| | - Martin M H Wong
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, 6/F, Esther Lee Building, Shatin, NT, Hong Kong
| | - K M Chow
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, 6/F, Esther Lee Building, Shatin, NT, Hong Kong
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Chung HO, Oczkowski SJW, Hanvey L, Mbuagbaw L, You JJ. Educational interventions to train healthcare professionals in end-of-life communication: a systematic review and meta-analysis. BMC MEDICAL EDUCATION 2016; 16:131. [PMID: 27129790 PMCID: PMC4850701 DOI: 10.1186/s12909-016-0653-x] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 04/26/2016] [Indexed: 05/15/2023]
Abstract
BACKGROUND Practicing 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. METHODS We 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. RESULTS Of 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. CONCLUSION Very 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 REGISTRATION PROSPERO CRD42014012913.
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Affiliation(s)
- Han-Oh Chung
- , 1280 Main Street West, HSC-2C8, Hamilton, Ontario, L8S 4K1, Canada.
| | - Simon J W Oczkowski
- Hamilton General Hospital, McMaster Clinic 4th floor, Room 434, 237 Barton St East, Hamilton, Ontario, L8L2X2, Canada
| | - Louise Hanvey
- Canadian Hospice Palliative Care Association, Annex D, Saint-Vincent Hospital, 60 Cambridge Street North, Ottawa, ON, K1R 7A5, Canada
| | - Lawrence Mbuagbaw
- , 1280 Main Street West, HSC-2C8, Hamilton, Ontario, L8S 4K1, Canada
- St Joseph's Healthcare, 50 Charlton Avenue East, 3rd Floor Martha Wing, Room H321, Hamilton, Ontario, L8N4A6, Canada
| | - John J You
- , 1280 Main Street West, HSC-2C8, Hamilton, Ontario, L8S 4K1, Canada
- St Joseph's Healthcare, 50 Charlton Avenue East, 3rd Floor Martha Wing, Room H321, Hamilton, Ontario, L8N4A6, Canada
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Efficacy of advance care planning: a systematic review and meta-analysis. J Am Med Dir Assoc 2014; 15:477-489. [PMID: 24598477 DOI: 10.1016/j.jamda.2014.01.008] [Citation(s) in RCA: 462] [Impact Index Per Article: 46.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 01/10/2014] [Accepted: 01/10/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To systematically review the efficacy of advance care planning (ACP) interventions in different adult patient populations. DESIGN Systematic review and meta-analyses. DATA SOURCES Medline/PubMed, Cochrane Central Register of Controlled Trials (1966 to September 2013), and reference lists. STUDY SELECTION Randomized controlled trials that describe original data on the efficacy of ACP interventions in adult populations and were written in English. DATA EXTRACTION AND SYNTHESIS Fifty-five studies were identified. Study details were recorded using a predefined data abstraction form. Methodological quality was assessed using the PEDro scale by 2 independent reviewers. Meta-analytic techniques were conducted using a random effects model. Analyses were stratified for type of intervention: 'advance directives' and 'communication.' MAIN OUTCOMES AND MEASURES Primary outcome measures were completion of advance directives and occurrence of end-of-life discussions. Secondary outcomes were concordance between preferences for care and delivered care, knowledge of ACP, end-of-life care preferences, quality of communication, satisfaction with healthcare, decisional conflict, use of healthcare services, and symptoms. RESULTS Interventions focusing on advance directives as well as interventions that also included communication about end-of-life care increased the completion of advance directives and the occurrence of end-of-life care discussions between patients and healthcare professionals. In addition, interventions that also included communication about ACP, improved concordance between preferences for care and delivered care and may improve other outcomes, such as quality of communication. CONCLUSIONS ACP interventions increase the completion of advance directives, occurrence of discussions about ACP, concordance between preferences for care and delivered care, and are likely to improve other outcomes for patients and their loved ones in different adult populations. Future studies are necessary to reveal the effective elements of ACP and should focus on the best way to implement structured ACP in standard care.
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Mueller PS, Litin SC, Hook CC, Creagan ET, Cha SS, Beckman TJ. A novel advance directives course provides a transformative learning experience for medical students. TEACHING AND LEARNING IN MEDICINE 2010; 22:137-141. [PMID: 20614380 DOI: 10.1080/10401331003656678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Inadequate physician training may be a barrier to physician-patient discussions of advance directives (ADs). DESCRIPTION The purpose of this study was to determine the effects of an ADs course, which includes completing a directive, on medical students' perceived knowledge of and preparedness for discussing ADs with patients. All 4th-year medical students completed a 10-hr bioethics course comprising interactive lecture and small-group discussion formats. Curriculum content included ethical and legal aspects of ADs. An 8-item survey with free-text entry was administered 1 month after course completion. Internal consistency reliability of survey scores was determined. Two authors independently coded the free-text comments and reached consensus on underlying themes. EVALUATION Of the 89 students who completed the survey (response rate 80%), 87 (98%) felt more knowledgeable and 88 (99%) better equipped to counsel patients about ADs. Forty-two (47%) reported they had counseled others to complete ADs during the month after the course. Internal consistency reliability of survey scores was very good (Cronbach's alpha =.78). Dominant themes of responses to the question, "What was the most eye opening, troubling, or difficult aspect about filling out your advance directive?" included difficulties articulating wishes, legal language, selecting a surrogate, and facing mortality. CONCLUSIONS These findings suggest an ADs course that includes completing a directive enhances medical students' empathy for and preparedness to discuss ADs with patients.
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Affiliation(s)
- Paul S Mueller
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Robison J, Curry L, Gruman C, Porter M, Henderson CR, Pillemer K. Partners in caregiving in a special care environment: cooperative communication between staff and families on dementia units. THE GERONTOLOGIST 2007; 47:504-15. [PMID: 17766671 DOI: 10.1093/geront/47.4.504] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE This article reports the results of a randomized, controlled evaluation of Partners in Caregiving in a Special Care Environment, an intervention designed to improve communication and cooperation between staff and families of residents in nursing home dementia programs. DESIGN AND METHODS Participants included 388 family members and 384 nursing staff members recruited from 20 nursing homes, randomly assigned to treatment and control conditions. Project staff conducted training sessions on communication and conflict-resolution techniques with two groups at the intervention sites: staff and residents' family members, followed by a joint meeting with facility administrators. RESULTS Families, staff, residents, and facility programs in the intervention facilities all demonstrated positive outcomes from program participation. Families experienced significant improvement in communicating with staff and in staff behaviors toward them, and spouses of residents increased their care involvement. Staff reported reduced conflict with families and reduced depression; burnout for nurses increased for individuals in the control group but not those in the treatment group. Behavioral symptoms decreased for residents, and facilities implemented more family-focused programs. IMPLICATIONS Effective staff and family partnerships are critical in caring for residents with dementia. The Partners in Caregiving in a Special Care Environment program is an evidence-based intervention that enables these partnerships to develop and thrive, translating into improved experiences for residents, families, and staff.
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Affiliation(s)
- Julie Robison
- Center on Aging, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-6147, USA.
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Han PKJ, Keranen LB, Lescisin DA, Arnold RM. The palliative care clinical evaluation exercise (CEX): an experience-based intervention for teaching end-of-life communication skills. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2005; 80:669-76. [PMID: 15980083 DOI: 10.1097/00001888-200507000-00009] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE To pilot test the "Palliative Care Clinical Evaluation Exercise (CEX)," a new experience-based intervention to teach communication skills in giving bad news and discussing code status. The intervention allows faculty to observe, evaluate, and give feedback to housestaff in their discussions with patients and families. METHOD In 2002-03, the intervention was piloted among 60 first-year residents in the categorical Internal Medicine Residency Programs at the University of Pittsburgh. The authors collected feasibility measurements at the time of intervention, and interns' attitudes were measured before and one week after intervention and at the end of the intern year. RESULTS Forty-four residents (73%) completed the intervention. Discussions averaged a total of 49.5 minutes (SD 24.1), divided among 12.7 minutes (SD 7.5) for prediscussion counseling between the resident and faculty observer, 25.6 minutes (SD 16.1) for the resident-patient discussion, and 12.1 minutes (SD 5.7) for postdiscussion feedback. Residents rated the Palliative Care CEX favorably (>3 on a five-point scale) on ease of arranging the exercise, educational value, quality of the experience, effect on their comfort with discussions, importance to their education, and value of preceptor feedback. Self-ratings of communication competence showed improvement one week after the intervention. CONCLUSIONS The Palliative Care CEX is feasible and positively valued by residents. The findings from this initial pilot study support the value of further efforts to refine the intervention, to confirm its feasibility in other settings, and to validate its use as an educational and assessment tool.
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Affiliation(s)
- Paul K J Han
- Division of Cancer Prevention, National Cancer Institute, Executive Plaza North, Room 4097, 6130 Executive Boulevard, Bethesda, MD 20852, USA.
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Pillemer K, Suitor JJ, Henderson CR, Meador R, Schultz L, Robison J, Hegeman C. A cooperative communication intervention for nursing home staff and family members of residents. THE GERONTOLOGIST 2003; 43 Spec No 2:96-106. [PMID: 12711730 DOI: 10.1093/geront/43.suppl_2.96] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE This article reports on a randomized, controlled study of Partners in Caregiving, an intervention designed to increase cooperation and effective communication between family members and nursing home staff. DESIGN AND METHODS Participants included 932 relatives and 655 staff members recruited from 20 nursing homes, randomly assigned to treatment and control conditions. Parallel training sessions on communication and conflict resolution techniques were conducted with the family and staff in the treatment group, followed by a joint meeting with facility administrators. RESULTS Positive outcomes were found for both family and staff members in the treatment group. Both groups showed improved attitudes toward each other, families of residents with dementia reported less conflict with staff, and staff reported a lower likelihood of quitting. IMPLICATIONS Multiple studies report significant interpersonal stress between family members of nursing home residents and facility staff members. Partners in Caregiving appears to be an effective way to improve family-staff relationships in nursing homes.
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Affiliation(s)
- Karl Pillemer
- Cornell Gerontology Research Institute and Department of Human Development, MVR G39, Cornell University, Ithaca, NY 14853, USA.
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Buss MK. Using a Patient Perspective to Improve Palliative Education: Helping Patients Go into That Good Night. J Palliat Med 1999; 2:391-5. [PMID: 15859779 DOI: 10.1089/jpm.1999.2.391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M K Buss
- Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15243, USA.
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Wilson IB, Green ML, Goldman L, Tsevat J, Cook EF, Phillips RS. Is experience a good teacher? How interns and attending physicians understand patients' choices for end-of-life care. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. Med Decis Making 1997; 17:217-27. [PMID: 9107618 DOI: 10.1177/0272989x9701700213] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Recent studies have shown that physicians do not accurately assess patients' health status or treatment preferences. Little is known, however, about how physicians' levels of training or experience relate to their abilities to assess these preferences. To better understand this phenomenon, the authors compared the abilities of medical interns and attending physicians to predict the choices of their adult patients for end-of-life care. METHODS 230 seriously-ill adult inpatients were surveyed about their desires for cardiopulmonary resuscitation, their current quality of life, and their attitudes toward six other common adverse outcomes. The medical intern and attending physician who cared for these patients were asked to estimate the patient's responses for all of the same items. Agreement was assessed using the kappa statistic. RESULTS Compared with interns, attending physicians had known patients longer, had talked with patients more frequently about prognosis, and felt they knew more about their patients' preferences (all p < .0001). Despite this, the attending physicians were no more accurate than the interns in assessing patients' preferences. Both interns and attending physicians had only a fair understanding of patients' preferences for cardiopulmonary resuscitation or their quality of life (kappa statistics 0.32 to 0.47), and even less understanding of their willingness to tolerate adverse outcomes (kappa statistics -0.03 to 0.37). CONCLUSIONS For this cohort of seriously ill patients, neither medical interns nor their attending physicians were consistently accurate in assessing patients' preferences, and attending physicians were not more accurate than medical interns. Attending physicians should not assume that they can infer patients' preferences any better than the interns caring for these hospitalized patients.
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Affiliation(s)
- I B Wilson
- Primary Care Outcomes Research Institute, Boston, MA, USA
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Mezey M, Bottrell MM, Ramsey G. Advance directives protocol: nurses helping to protect patient's rights. The NICHE faculty. Geriatr Nurs 1996; 17:204-9; quiz 210. [PMID: 8924119 DOI: 10.1016/s0197-4572(96)80202-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Nurses can improve end-of-life decision making for patients by understanding the related legal, ethical and cultural issues involved and by encouraging the use of advance directives.
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Abstract
The advance directive has been acknowledged widely by patients and physicians as a desirable tool to promote patient autonomy at the end of life. Rates of completion of advance directives, however, remain low among all segments of the population. Significant patient and physician barriers to completion of advance directives are considered. Legal and ethical principles of advance directives, as well as some practical means of overcoming barriers to these important discussions, are reviewed.
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Affiliation(s)
- C A Arenson
- Department of Family Medicine, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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