Serious Illness Conversation Training for Inpatient Medical Oncology Advanced Practice Providers: A Quality Improvement Project.

Jo Clarke, Mary Alice Momeyer, Robin Rosselet, Loraine Sinnott, Janine Overcash
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Abstract

Background: Hospitalized advanced cancer patients and their families are inadequately informed about their cancer diagnosis and prognosis, which limits educated and reasonable decision-making for their care and end-of-life planning.

Objectives: The primary objective of this evidence-based project was to enhance serious illness conversations (SICs) with advanced cancer patients by providing advanced practice providers (APP) training and to increase the frequency of SIC documentation in the electronic medical record (EMR).

Methods: SIC training included a 45-minute Zoom video recording and 30-minute discussion groups. Advanced practice providers' beliefs and self-efficacy were measured pre- and post-training via a survey. Prior training was queried in the pre-survey. Data from APP discussion groups were summarized and themes identified. Serious illness conversation documentation frequency was measured. Pre- and post-survey differences were assessed using Wilcoxon rank sum tests.

Findings: 19 inpatient medical oncology nurse practitioners and 6 physician assistants participated. Many reported little formal training yet are engaging in SICs regularly. Scores on both the belief and self-efficacy survey sections were high prior to training and did not significantly change following training. Despite the high pre-survey scores, many of the APPs verbalized the need for more training to improve their confidence and to learn SIC communication skills. Training significantly improved the APP's ability to manage their own emotions and be present. This indicates a trend toward improved APP comfort with SICs. Accessible documentation in the EMR increased with training.

Abstract Image

Abstract Image

为住院肿瘤内科高级执业医师提供重症对话培训:质量改进项目。
背景:住院的晚期癌症患者及其家属对癌症诊断和预后了解不足,这限制了他们在护理和临终规划方面做出明智合理的决策:本循证项目的主要目标是通过提供高级医疗服务提供者(APP)培训来加强与晚期癌症患者的重病对话(SIC),并增加电子病历(EMR)中记录重病对话的频率:SIC 培训包括 45 分钟的 Zoom 视频录制和 30 分钟的小组讨论。培训前后,通过调查问卷对高级医疗服务提供者的信念和自我效能进行测量。在培训前调查中询问了培训前的情况。对 APP 讨论小组的数据进行总结并确定主题。对重病谈话记录频率进行了测量。采用 Wilcoxon 秩和检验评估调查前后的差异:19名住院肿瘤内科执业护士和6名助理医师参与了调查。许多人表示几乎没有接受过正规培训,但仍定期参与 SIC。培训前,信念和自我效能调查部分的得分都很高,培训后没有明显变化。尽管培训前的调查得分很高,但许多助产士仍表示需要接受更多的培训,以提高他们的自信心和学习 SIC 沟通技巧。培训极大地提高了 APP 管理自身情绪和临场表现的能力。这表明 APP 与 SIC 相处的舒适度有提高的趋势。通过培训,医疗记录系统中的可访问文档有所增加。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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