Advanced Care Directives: Overcoming the Obstacles.

Area of Science:

• Medical Education
• Palliative Care
• Health Services Research

Background:

• Advanced care directives (ACDs) and end-of-life discussions are crucial but often neglected by resident physicians due to sensitive topics and clinical pressures.
• Resident physicians frequently lack opportunities to initiate these vital conversations in their continuity clinics.

Purpose of the Study:

• To enhance resident physicians' opportunities for discussing end-of-life wishes with patients.
• To improve resident physicians' confidence in leading discussions about advanced care directives (ACDs).

Main Methods:

• A formalized curriculum including didactics, simulations, and academic detailing was implemented for 95 internal medicine residents.
• Clinic workflow modifications prompted staff to inquire about ACDs and cue residents for discussions when needed.

Main Results:

• 77% of patients were asked about ACDs, with 74% lacking one but expressing interest in discussion.
• Following the intervention, 65% of residents reported conducting at least one outpatient ACD discussion.
• Residents showed statistically significant increases in confidence for advanced care planning discussions and family meetings (P < .01).

Conclusions:

• A structured curriculum and supportive clinical environment empower resident physicians to increase ACD discussions and confidence.
• Patients demonstrate consistent interest in discussing their end-of-life wishes when given the opportunity and information.