81. CONVERSATION STARTERS, PART 2: RESIDENT EXPERIENCES WITH ADVANCE CARE PLANNING

Abstract

Introduction

Advance Care Planning (ACP) is an important yet underutilized process. While taught and practiced more heavily in other specialties, psychiatry residents have little exposure to it. However, psychiatrists are well-positioned to have these complex discussions, discussing patient values, and assessing capacity. A previous poster presented in 2024 examined resident perceptions of ACP. Here, we present results from a workshop training psychiatry residents to conduct ACP discussions as part of their outpatient Geriatric Psychiatry clinic.

Methods

As part of an introduction to the outpatient training year and outpatient geriatric psychiatry clinic, general psychiatry residents were given a one-hour lecture on medical advance care planning. This discussed the evidence supporting advance care planning and its components, and included an experiential activity of residents completing their own Values worksheets through the National Institute on Aging. They were provided with copies of legal documents for designating a Medical Power of Attorney and an advance directive, and instructed how to direct patients to appropriate resources. Surveys were given before and after the activity to assess residents’ knowledge and comfort with aspects of ACP.

Results

n=9 PGY2 residents completed pre- and post- surveys of the ACP workshop. Wilcoxan signed-rank test was used as a non-parametric test due to low sample size. Residents rated significant improvement (p LESS THAN 0.05) in general knowledge about ACP and its components, filling out ACP paperwork and directing patients to further resources, improved confidence in initiating and conducting ACP discussions with their patients. There was not a significant difference between rating concerns about having enough time to discuss ACP, and that ACP should be conducted primarily by other specialties.

Prior to the workshop, residents also rated lacking knowledge and experience as barriers to engaging in ACP with their patients. Self-rated confidence regarding knowledge of ACP improved (p LESS THAN 0.5) on post-test.

Conclusions

In this small pilot study, psychiatry residents improved their knowledge and confidence in conducting advance care planning discussions with their patients. We will also present data regarding the actual rate of documented ACP conversations in new patient intake and patient transfer appointments mid-way (6 months) into the outpatient training year, and qualitative data regarding the residents’ experience with ACP. Future work will aim to teach residents about advance care planning specifically in people with or at high risk for neurocognitive disorders.