Duthie EA, Galambos CM, Frederick T, Verkuilen J, Jessick T. Goals of care conversations: an evaluation. Poster presented at: Aurora Scientific Day; May 22, 2019; Milwaukee, WI.
Poster presented at: Aurora Scientific Day; May 22, 2019; Milwaukee, WI.
Background: Growing evidence suggests that physician and patient discussions about goals of care improve quality of life, quality of dying, and decrease end-of-life intensity of care. However, these conversations do not occur at the frequency desired by seriously ill and dying patients. Practitioners recommend new approaches to increase the frequency and quality of such conversations. The “Teaching Primary Palliative Care” training offered through Aurora Health Care’s continuing professional development office is one new approach aimed to equip physicians with skills to increase the frequency and quality of goals of care conversations.
Purpose: To evaluate the Teaching Primary Palliative Care (TPPC) training to determine if physicians report increased comfort in engaging in goals of care conversations with seriously ill and dying patients posttraining.
Methods: TPPC training occurs in three stages. Stage A: Initial self-assessment completed online. Participants complete a survey in which they answer a series of questions designed to measure comfort level in engaging in goals of care communications with their seriously ill and dying patients. Stage B: Attend an in-person training session on communication skills and techniques on having goals of care conversations with patients. Stage C: Second self-assessment completed online within about 3 months after physicians practiced and applied skills in their clinical practice. In fall 2018, 78 Aurora physicians completed stages A and B of the training, resulting in 37 completed stage A and stage C selfassessments. To assess for increased comfort level, the stage A and stage C assessments were statistically analyzed using the 1-sided sign test.
Results: Compared to their reported comfort level prior to completing TPPC training, physicians’ comfort level after training increased in 4 out of 5 circumstances related to engaging in goals of care conversations with patients: discussing CPR/do not resuscitate (P=0.018); discussing hospice or palliative care referral (P<0.001); discussing artificial hydration or nutrition (P=0.001); and discussing prognosis specifics (P=0.002).
Conclusion: Findings suggest that TPPC training increases the comfort level of physicians to engage in goals of care conversations with seriously ill and dying patients. Next steps for this project include a longitudinal study to determine whether physicians continue to be more comfortable in these circumstances 6–9 months after completing the training.