Family physicians enhance end-of-life care: evaluation of a new continuing medical education learning module in British Columbia

Abstract

BackgroundThe Practice Support Program (PSP) is an innovative peer-to-peer continuing medical education (CME) program that offers full-service family physicians/general practitioners (GPs) in British Columbia (BC), Canada, post-graduate training on a variety of topics. We present the evaluation findings from the PSP learning module on enhancing end-of-life (EOL) care within primary care.MethodsPen-and-paper surveys were administered to participants three times: at the beginning of the first training session (n = 608; 69.6 % response rate), at training completion (n = 381, 55.6 % response rate), and via a mail-out survey at 3-6 months following training completion (n = 109, 24.8 % response rate). Surveys asked GPs about current EOL-related practices and confidence in EOL-related skills. At end of training, respondents also provided ratings of satisfaction and perceptions of the module’s impact on their practice and their EOL patients.ResultsSatisfaction and impact were rated very highly by over 90 % of the GP respondents. Module participation increased the GPs’ confidence on EOL-related communication and collaboration skills: e.g., initiating conversations about EOL care, developing an action plan for EOL care, communicating the patient’s needs and wishes to other care providers, participating in collaborative care with home and community care nurses, and accessing and referring patients to EOL specialists in the community. Increased confidence was maintained at 3-6 months following completion of training.ConclusionsThe EOL learning module offered by the PSP to family physicians in BC is a successful and impactful CME accredited training module for enhancing end-of-life care in primary care settings.

Resources for Educating, Training, and Mentoring All Physicians Providing Palliative Care

“…42 Peer-to-peer support and mentorship approaches are a key feature of effective faculty development initiatives and a peer-to-peer continuing education program was successful for improving confidence and knowledge among practicing physicians in British Columbia. 43 Most recently, the ''Quality End of Life Care for All'' (QELCA) program in the United Kingdom has allowed practicing physicians to experience hospice care through a five-day clinical immersive experience. They then bring that experience back to their own practices as part of a longitudinal learning project.…”

Provider Tools for Advance Care Planning and Goals of Care Discussions: A Systematic Review

“…Almost all of the studies 7,8,[14][15][16][18][19][20][21][22]24,25,27,32,[35][36][37][38][41][42][43]45,46,49,53 had a moderate risk of bias, 3 studies had low risk of bias, 13,28,54 and 5 studies had a serious risk of bias. 10,11,17,33,34 Outcomes Initiating and facilitating ACP or GoC discussions Adult Studies. No clear distinction has been made between clinical tools that either introduce or facilitate both ACP and GoC discussions, and as such, these 2 search criteria were combined.…”

“…Adult studies Boettcher et al 7 Respecting Choices Repeated measures Davis 8 Conversation Project Qualitative evaluation Hickman et al 9 POLST Systematic review Kadlec et al 10 Practice 22 EpicCare HER Chart review Au et al 23 NA Cluster-RCT Clayton et al 24 PREPARED Pre/poststudy Colville and Kennedy 25 NA Descriptive qualitative study Green and Levi 26 MYWK RCT Resnick et al 27 NA Survey Detering et al 2 Respecting Choices RCT Hammes et al 28 37 NA Pre/poststudy Zapka et al 38 NA Pre/poststudy Pearlman et al 39 Your Life, Your Choices RCT Song et al 40 PC-ACP RCT Wissow et al 41 NA Prospective, quasiexperimental Ahrens et al 42 NA Prospective comparison Bricker et al 43 NA Descriptive Schwartz et al 44 Respecting Choices RCT Pauls et al 45 NA Descriptive Ratner et al 46 Kitchen Table Discussion Case Series exposure to a Respecting Choices type of intervention, compared to controls, can result in: increased advance directive (AD) completion 2,7,13 ; increased appointment of a surrogate 2 ; more involvement in EOL decisions 2 ; increased consistency between patient wishes and medical interventions undertaken at EOL 2,28 ; increased patient and surrogate satisfaction with care received 2 ; increased ACP knowledge 29,30,44 ; fewer symptoms of anxiety and depression in family members of decedents 2 ; decreased decisional conflict 40 ; and increased consistency between wishes of patients and their surrogates. 29,30,40,…”

Palliative care training addressed to hospital healthcare professionals by palliative care specialists: a mixed-method evaluation

“…Although the literature does describe several training interventions in PC [20–23], unfortunately, it rarely reports information about assessment tools used [24] or the methodological validity. A recent review by Turrillas et al [25] has recognized an enormous lack of evidence for PC training evaluation.…”