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Related Experiment Video

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Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care
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Advanced Care Directives: Overcoming the Obstacles.

Sarah Leatherman Allen, Kimberly S Davis, Paul C Rousseau

    Journal of Graduate Medical Education
    |July 29, 2015
    PubMed
    Summary
    This summary is machine-generated.

    Resident physicians can increase advanced care directive (ACD) discussions with patients through targeted training and workflow changes. This program improved resident confidence and patient engagement in end-of-life planning.

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    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.