A Training Targeting Advance Care Planning Skills for Medical, Nursing, and Social Work Students
Background: Research shows only 30% of Americans have advance directives (ADs). The lack of ADs may create challenges for families and health care professionals (HCPs) who must make critical, medical decisions on a patient’s behalf with limited information. HCPs are particularly suited to lead advance care planning (ACP) conversations. However, inconsistent implementation of ACP material in academic curricula may contribute to HCPs’ perceptions of low self-efficacy and discomfort in leading ACP, which represent significant barriers to care delivery. This intervention advanced prior interventions and aimed to evaluate a clinical-educational intervention on ACP with students in schools of medicine, nursing, and social work.
Design: This study used randomized controlled trial design. Participants attended three educational ACP training modules. They were then randomized into either completion of clinical ACP scenarios with a standardized patient or observation of a faculty champion having ACP discussions with patients. Observerships were uncompleted, due to COVID-19. Surveys were completed prior to training modules (T1 [n = 35]), upon conclusion of the third training module (T2 [n = 20]), and after the randomized clinical interventions six months later (T3 [n = 22]). Matched T1-T3 data analysis is currently underway. This final sample (N = 15) included students from medicine (66.7%), nursing (13.3%), and social work (20.0%). Participants were primarily young (M=27 years), non-Hispanic (93.3%), White (66.7%), and female (73.3%). Primary measures of interest included communication self-efficacy, ACP self-efficacy, and interprofessional teamwork. Paired t tests examined change from T1 to T2.
Results: Despite worse communication self-efficacy (Mdiff=1.8, p < .001) and ACP self-efficacy (Mdiff=1.1, p < .001), perceptions of interprofessional teamwork improved (Mdiff=�'3.1, p=.008). These fluctuations suggest participants initially overestimated their self-efficacy related to ACP at T1 and corrected their appraisals at T2. Preliminary T3 data showed further decreases. T3 communication self-efficacy (M=3.0) and ACP self-efficacy (M=1.9) were lower than T1 and T2. Though higher than T1, T3 perceptions of interprofessional teamwork (M=45.6) were lower than T2.
Conclusion: These T1�"T2 findings mirror previous evaluations of educational modules, discovering that both self-efficacy outcomes worsened at T2, but improved at T3. With the exception of increased interprofessional teamwork, this study found unfavorable T3 results. These findings may be explained, in part, by COVID-19’s threat to internal validity. The research team’s prior studies showed large T2�"T3 increases, suggesting that this intervention would have otherwise followed suit.
Implications: Replicating the intervention with minimized threats to validity is necessary.
Funded by University of Maryland IPEC SEED Grant, 2019.