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AD-LAST! An interdisciplinary clinical workshop to improve cultural and spiritual awareness in advance care planning skills

Published online by Cambridge University Press:  15 March 2022

Cynthia X. Pan Open the ORCID record for Cynthia X. Pan [Opens in a new window] ,
Alexandra Spinelli Open the ORCID record for Alexandra Spinelli [Opens in a new window] ,
Evgenia Litrivis ,
Ariana Popoviciu ,
Kelly Persaud Thomson  and
Elizabeth Brondolo Open the ORCID record for Elizabeth Brondolo [Opens in a new window]
Cynthia X. Pan*
Affiliation:
Division of Geriatrics and Palliative Care Medicine, New York-Presbyterian Queens, Flushing, New York, NY
Alexandra Spinelli
Affiliation:
Department of Psychology, St. John's University, Jamaica, New York, NY
Evgenia Litrivis
Affiliation:
Division of Geriatrics and Palliative Care Medicine, New York-Presbyterian Queens, Flushing, New York, NY
Ariana Popoviciu
Affiliation:
Department of Psychology, St. John's University, Jamaica, New York, NY
Kelly Persaud Thomson
Affiliation:
Division of Geriatrics and Palliative Care Medicine, New York-Presbyterian Queens, Flushing, New York, NY
Elizabeth Brondolo
Affiliation:
Department of Psychology, St. John's University, Jamaica, New York, NY
*
Author for correspondence: Cynthia X. Pan, Division of Geriatrics and Palliative Care Medicine, New York-Presbyterian Queens, Weill Cornell Medical College, 56-45 Main Street, Flushing, NY 11355, USA. E-mail: cxp9001@nyp.org
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Abstract

Objectives

Clinicians report training deficits in advance care planning (ACP), including limits to their understanding of cultural/spiritual influences on patient decision-making and skills in interdisciplinary teamwork. This study describes Advance Directives-Live Action Simulation Training (AD-LAST), an interdisciplinary experiential and didactic training program for discussing ACP and end-of-life (EOL) care. AD-LAST highlights cultural/spiritual variations in medical decision-making.

Methods

Prospective educational cohort study with pre-post intervention survey. AD-LAST incorporated standard curricular tools for didactic and experiential training in ACP/EOL communication. Study conducted in an urban community teaching hospital in Queens, NY, one of the most diverse counties in the USA. Participants included physicians, house staff, nurses, therapists, and other disciplines. AD-LAST format was a one-day workshop. The morning focused on didactic teaching using widely available curricular tools. The afternoon involved experiential practice with standardized patient-actors. Pre-post intervention questionnaires assessed ACP operational knowledge and self-efficacy (i.e., self-confidence in skills) in ACP and EOL communication. Repeated measure ANOVAs evaluated changes from pretest to posttest in knowledge and self-efficacy.

Results

A total of 163 clinical staff participated in 21 AD-LAST training sessions between August 2015 and January 2019. Participants displayed a significant increase from pretest to posttest in total knowledge (p < 0.001), ACP procedural knowledge (p < 0.001), ACP communication/relationships knowledge (p < 0.001), and self-efficacy (p < 0.001). Knowledge and self-efficacy were not correlated and represented independent outcomes. Postprogram evaluations showed greater than 96% of participants were highly satisfied with AD-LAST, especially the opportunity to practice skills in real-time and receive feedback from members of other professional groups.

Significance of results

AD-LAST, a multifaceted training program deployed in an interdisciplinary setting, is effective for increasing ACP knowledge and self-efficacy, including the capacity to address cultural/spiritual concerns. The use of standard tools facilitates dissemination. The use of case simulations reinforces learning.

Keywords

Advance care planningCultural/spiritual competenceEnd-of-life careInterdisciplinary teamsTraining curriculum
Type
Original Article
Information
Palliative & Supportive Care , Volume 21 , Issue 3 , June 2023 , pp. 422 - 428
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Copyright
© The Author(s), 2022. Published by Cambridge University Press

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