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Multimodal Pediatric Advance Care Planning Training for Neonatal Intensive Care Unit and Palliative Care
Tamiko Younge1, Hailey Moore, Laila A Mahmood
1Dr. Younge: Neonatal-Perinatal Medicine Fellow, Division of Neonatology, Children's National Hospital, Washington, DC. Ms. Moore: Clinical Research Assistant, Center for Health Outcomes Research Delivery Sciences, Children's National Research Institute, Children's National Hospital, Washington, DC. Dr. Mahmood: Associate Professor, George Washington University School of Medicine and Health Sciences, Attending Physician, Palliative Medicine and Hematology/Oncology, Children's National Hospital, Washington, DC. Dr. Thompkins: Research Nurse, Center for Health Outcomes Research Delivery Sciences, Children's National Research Institute, Children's National Hospital, Washington, DC. Dr. Chandereng: Faculty Biostatistician, Center for Health Outcomes Research Delivery Sciences, Children's National Research Institute, Children's National Hospital, Washington, DC. Dr. Lyon: Professor of Pediatrics, George Washington University School of Medicine and Health Sciences, Center for Genetic Medicine Research, Children's National Research Institute, Center for Health Outcomes Research Delivery Sciences, Children's National Research Institute, Children's National Hospital, Washington, DC.
Introduction:
Pediatric advance care planning is an iterative process that supports families in sharing their values, hopes, and preferences for their child's future medical care. Advance care planning rarely occurs in the neonatal intensive care unit (NICU), and if it does, it is often without the benefit of high-quality practitioner training. We evaluated a multimodal, high-fidelity pediatric advance care planning training for NICU and palliative care practitioners.
Methods:
We conducted a pilot evaluation study of the Respecting Choices® Next Steps Family-Centered Pediatric Advance Care Planning facilitator training. Training included online modules, live class, and mock interviews with standardized patients. Learners reported self-efficacy, barriers, and utilization before, after, and 3 months after training. Analysis included paired t tests adjusted for multiple tests.
Results:
A total of 18 practitioners completed the training and certification. Advance care planning self-efficacy increased after training (difference = 0.68, 95% CI [0.34 to 1.0]) and remained stable after 3 months (difference = 0.03, 95% CI [-0.24 to 0.3]). Practitioners' confidence in performing individual steps of advance care planning increased significantly 3 months after training compared with baseline. Eleven learners reported applying learned skills in their practice, and six learners reported facilitating advance care planning with 13 families.
Discussion:
Pediatric advance care planning facilitator training was effective and used by an interdisciplinary group of practitioners working in the NICU. Future work includes incorporating advance care planning into NICU workflow, supporting skill maintenance, and studying effect on patient care.
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