Promoting Advanced Care Planning and Goals of Care Conversations: An Educational Intervention

Abstract

Background. Goals of care conversations are conversations between the clinician and patient or their surrogate to determine a patient’s values, goals, and preferences for care. These conversations often address advanced care planning and life-sustaining treatment initiatives. The acute care hospital has the potential to serve as a critical site in which clinicians can conduct these conversations and document their patient’s goals of care and life-sustaining treatment decisions in the electronic health record. However, despite a growing awareness that these conversations are vital to supporting a patient-centered approach to care, uptake in the acute care setting remains low. Purpose. The purpose of this QI project is two-fold. The primary purpose of this project was to increase providers' intent to engage in goals-of-care conversations and advanced care planning with their patients and complete related life-sustaining treatment documentation. This project also served to identify providers' perceived barriers and facilitators to having these conversations and completing related documentation at the local level – SAVAHCS acute care setting. Methods. This quality improvement project used a teaching intervention delivered both synchronously and asynchronously to address the projects’ aims and a descriptive qualitative approach to assess the efficacy of the teaching intervention. Results. Eight participants from either the synchronous or asynchronous group completed the teaching intervention and the posttest survey. All five Likert-style questions addressing knowledge, comfort, understanding of resources, and intent to engage in GoC conversations addressing life-sustaining treatments demonstrated a positive result – a score of “2” or greater on the Likert scale. Common themes identified in this study include a lack of time to have goals of care conversations and the need for better staffing to address this barrier. Conclusion. A short teaching intervention improves clinicians’ subjective knowledge of, comfort with, attitudes towards, and intent to engage in goals of care conversations and advanced care planning with their patients.