2025 Scholars' Research Symposium Abstract: Minimizing Grief and Loss Through Advanced Care Planning.

Abstract

Introduction: Advanced care planning (ACP) is a process that enables patients to specify their preferences for healthcare should they become unable to communicate their wishes. With the global population aged 60 and older comprising 11% of the total population-projected to rise to 22% by 2050-the need for ACP is increasingly urgent. This issue is even more pronounced in rural areas, like South Dakota, where older and sicker populations are disproportionately represented. Despite the numerous benefits of ACP, only 28% of adults in South Dakota have an advanced directive, and alarmingly, between 65% and 76% of physicians are unaware of their patients' existing advanced directives.

Methods: Healthcare professionals who work with vulnerable adult populations were recruited through partnerships with long term care organizations and personnel to participate in an educational program. The program consisted of four separate one-hour long virtual sessions over the lunch hour once monthly and were designed to enhance understanding and use of ACP tools. The program consisted of four discussion-based sessions, focused on the personal grief experienced during the COVID-19 pandemic and how it intersected with the practice of ACP. Half of each session involved didactics, and half was discussion-based facilitated by a physician with extensive long term care experience. Continued medical education credits were provided. Session topics included: 1. Moving forward after the Covid-19 pandemic, 2. Appropriate use of the Medical Order for Scope of Treatment (MOST) form 3. Shared decision making, and 4. Communicating when emotions are intense. Evaluation methods included pre- and post-program knowledge surveys and the Professional Quality of Life Scale (ProQOL), which assesses compassion, satisfaction, burnout, and secondary trauma stress.

Results: The program had variable attendance, with participants from diverse professional roles and settings including nursing, EMS workers, chaplains, administrators, social workers, hospice, community health workers, educators, and physicians. The first session had 58 participants, the second had 42, the third had decreased attendance at 23, and the fourth session had 53 total participants. Post-session evaluations revealed a small, statistically insignificant improvement across all ProQOL subcategories. Notable improvements were observed in participants' confidence and competence in using ACP tools appropriately.

Conclusions: The educational sessions successfully increased health care professionals' comfort in using ACP tools and enhanced their professional well-being. The sessions fostered valuable discussions among participants from various settings including long term care facilities, assisted living facilities, emergency services, and administration. Much of the discussion helped to address difficult topics related to end-of-life care. Despite positive outcomes, the study was limited by participants not completing all four sessions. Future research should explore the application of implementation science to better integrate ACP tools and training into clinical settings, enhancing both patient care and provider support.