Continuing Education Outcomes for Advance Care Planning: A Systematic Review of the Literature

Abstract

Introduction: Advance care planning (ACP) is a process of considering future health and care needs for a time when a person may be unable to speak for themselves. Health professional continuing education programs have been proposed for facilitating patient participation in ACP; however, their impacts on participants, patient and clinical outcomes, and organizational approaches to ACP are not well understood. Methods: This systematic literature review examined interventional studies of education programs conducted with health professionals and care staff across a broad range of settings. Five electronic databases were searched up to June 2020, and a manual search of reference lists was conducted. The quality of studies was appraised by the first, second, and third authors. Results: Of the 7993 articles identified, 45 articles met the inclusion criteria. Program participants were predominantly medical, nursing, and social work staff, and students. Interventions were reported to improve participants' self-perceived confidence, knowledge, and skills; however, objectively measured improvements were limited. Multimodal programs that combined initial didactic teaching and role-play simulation tasks with additional activities were most effective in producing increased ACP activity in medical records. Evidence for improved clinical outcomes was limited. Discussion: Further studies that use rigorous methodological approaches would provide further evidence about what produces improved patient and clinical outcomes. Needs analyses and quality indicators could be considered to determine the most appropriate and effective education resources and monitor their impacts. The potential contribution of a broader range of health professionals and interprofessional learning approaches could be considered to ultimately improve patient care.

Radiology for anatomy educators: Success of an online, 2‐day course for radiology training

“…In addition, attendees of CE courses show a significant improvement in their confidence as a result of their attendance. This result was consistent across fields including medical providers, nurses, social workers, and students 35 …”

“…31 Several research studies have supported this theory by demonstrating the most effective approach to adult education is the use of multimodal techniques that rely on goal-oriented, active learning strategies. [32][33][34][35] Additionally, these principles of constructivism align nicely with radiology education. Multiple studies have shown that the most effective, evidence-based approach to teaching radiology is active learning, particularly case-based (CBL) or team-based learning (TBL).…”

“…Here, concepts were introduced with didactic lectures providing information on imaging background, identification of normal images, and identification of abnormal images followed by application through case studies. This course organization has been shown to be more effective in radiology education than using more student‐led education 35,47 …”

“…This course organization has been shown to be more effective in radiology education than using more student-led education. 35,47 Furthermore, attendees had overwhelmingly positive feedback for the course. They frequently mentioned the use of relevant, easily understood, case-studies to practice their newly learned knowledge as an advantage of the course.…”

Evaluation of an advance care planning training program for practice professionals in Japan incorporating shared decision making skills training: a prospective study of a curricular intervention

“…Although the dialog is important in ACP practice and should begin when the patient can still participate in such discussions, it has become clear that many physicians and nurses in Japan do not want to initiate discussions before the patient’s condition worsens [ 10 ]. Moreover, although the conversation between patients and specialists in the field of palliative care is [ 11 ], the practice of such is reportedly difficult, and few educational programs on ACP practice have been confirmed effective [ 12 ].…”