Improved resident physician confidence with advance care planning after an ambulatory clinic intervention

Ericka E Tung, Mark L Wieland, Brandon P Verdoorn, Karen F Mauck, Jason A Post, Matthew R Thomas, John B Bundrick, Thomas M Jaeger, Stephen S Cha, Kris G Thomas
American Journal of Hospice & Palliative Care 2014, 31 (3): 275-80
Many primary care providers feel uncomfortable discussing end-of-life care. The aim of this intervention was to assess internal medicine residents' advance care planning (ACP) practices and improve residents' ACP confidence. Residents participated in a facilitated ACP quality improvement workshop, which included an interactive presentation and chart audit of their own patients. Pre- and postintervention surveys assessed resident ACP-related confidence. Only 24% of the audited patients had an advance directive (AD), and 28% of the ACP-documentation was of no clinical utility. Terminally ill patients (odds ratio 2.8, P < .001) were more likely to have an AD. Patients requiring an interpreter were less likely to have participated in ACP. Residents reported significantly improved confidence with ACP and identified important training gaps. Future studies examining the impact on ACP quality are needed.

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