Goals-of-Care Conversations and Covid-19: Using a Brief Educational Module to Empower Generalist Clinicians at the Southern AZ VA Health Care System

Abstract

Purpose: To evaluate the effect of a brief educational module on the self-reported knowledge, confidence, and intent of generalist clinicians to conduct goals-of-care conversations with hospitalized COVID-19 patients at the Southern Arizona Veterans Affairs Health Care System (SAVAHCS) in Tucson, Arizona. Background: The COVID-19 pandemic has led to an influx of seriously ill hospitalized patients who need their goals of care rapidly established to guide medical treatment decisions. Generalist clinicians have had to conduct these conversations more frequently due to large patient volumes and a shortage of palliative care specialists. However, generalists often report feeling underprepared due to limited formal goals-of-care communication training. Several recent studies have shown that educational interventions can improve goals-of-care-related knowledge, confidence, and skill levels. The Reframe, Expect emotion, Map outpatient goals, Align with goals, and Propose a plan (REMAP) communication framework is a structured, evidence-based approach to goals-of-care conversations that has been shown to increase the knowledge, confidence, and skill levels of generalists across multiple disciplines. Methods: Generalists at the SAVAHCS completed a web-based educational module that demonstrated the application of the REMAP framework to a COVID-specific case scenario. Participants completed pre- and post-intervention questionaries. Primary outcomes were changes in self-reported knowledge and confidence levels. Secondary outcomes included post-intervention feelings of preparedness and intention to conduct goals-of-care conversations. Results: Three participants completed the pre- and post-intervention questionnaires. All three participants reported an increase in their knowledge levels, and two out of three reported an increase in their confidence levels. Neither of the differences in means was statistically significant. All three participants strongly agreed that they felt more prepared and had a stronger intention to conduct goals-of-care conversations after completing the module. All participants agreed that participation in the project would change or improve their practice. Conclusions: The results of this project suggest that a brief online educational module that demonstrates the application of an evidence-based goals-of-care communication framework can improve generalists’ knowledge, confidence, and intent to conduct goals-of-care conversations with hospitalized COVID-19 patients.