Transcript Teaching others Palliative care communication skills: piloting an

Piloting an Interprofessional
Education Workshop:
Teaching others palliative care communication skills
Neha J. Darrah, MD
Diane Hadley, PharmD BCACP
Amy Corcoran MD CMD FAAHPM
Geriatrics Grand Rounds
April 4, 2014
Disclosures
• We have no relevant financial disclosures;
however, a portion of this project was supported
by funds from the Health Resources and Services
Administration (HRSA) under Geriatric Academic
Career Award K01HP20493 and the GEC grant
UB4HP19214.
• The information or content and conclusions are
those of the author and should not be construed
as the official position or policy of, nor should any
endorsements be inferred by the DHHS, HRSA,
BHPR, or the U.S.
Learning Objectives
To describe the main objective for an effective
interprofessional, education workshop
To list the essential elements for a successful
interprofessional, education workshop
Overview
• IPE BACKGROUND
• IPE and palliative care
• Workshop history
• Workshop description
• Results
• Study limitations
• Future implications
What is IPE?
Interprofessional Education (IPE)
• Defined as students from two or more professions learning
about, from and with each other to enable effective
collaboration and improve health outcomes (WHO, 2010)
Goal of IPE
• Prepare health professional students for deliberately
working together
• Provide high quality, patient-centered care
Barriers to IPE
Logistics
Professional hierarchies/stereotypes
Institutional resistance
Strategies for IPE
Classroom didactics
Practice based interventions
Experiential Strategies
• Role play
• Simulation exercises
Interprofessional Education
Collborative (IPEC)
• Organizations involved
– American Association of Colleges of Nursing
– American Association of College of Osteopathic
Medicine
– Association of schools of Public Health
– American Association of Colleges of Pharmacy
– American Dental Education Association
– Association of American Medical Colleges
Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel.
Washington, D.C.: Interprofessional Education Collaborative. Available at: http://www.aacn.nche.edu/education-resources/ipecreport. Accessed April 1,
2014.
Interprofessional Collaborative Practice Domains
from Interprofessional Education Collaborative
(IPEC) 2011
Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional
collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative.
Available at: http://www.aacn.nche.edu/education-resources/ipecreport. Accessed April 1, 2014.
Overview
• IPE Background
• IPE AND PALLIATIVE CARE
• Workshop history
• Workshop description
• Results
• Study limitations
• Future implications
Why is IPE Relevant to Palliative
Care?
Palliative care is specialized medical care for
people with serious illnesses. Palliative care is
provided by a TEAM of doctors, nurses, and
other specialists (social work, chaplaincy,
pharmacy) who work together with a patient’s
other doctors to provide an extra layer of
support.
Past IPE Palliative Care Workshops
Palliative care: A suitable setting for undergraduate
interprofessional education
• Description: Interprofessional student workshops with family
care providers
• Recruited Learners: Medical, nursing, social work,
physiotherapy, and occupational therapy students
• Results: Students value and enjoy opportunity to work together
and find the experience moving, informative, and interesting
Wee B, Hillier R, Coles C, et al. Palliative care: a suitable setting for
undergraduate interprofessional education. Palliat Med. 2001 Nov; 15 (6) 48792.
Past IPE Palliative Care Workshops
Using simulated patients in a multiprofessional
communication skills programme: reflections from the
programme facilitators
• Description: Multiprofessional, 4-day communication skills
program with standardized patients
• Recruited learners: Predominantly nursing with some
physiotherapist, dieticians, and radiographers
• Results: No formal evaluation but feedback was positive
Donovan T, Hutchinson T, and Kelly A. Using simulated patients in a
multiprofessional communication skills programme: reflections from the
programme facilitators. Eur J Cancer Care. 2003 Jun; 12(2): 123-8
Past IPE Palliative Care Workshops
Enhancing interprofessional education in end-of-life
care: An interdisciplinary exploration of death and
dying in literature
•
Description: 12-week elective focused on reflections of dying
depicted in the literature
•
Recruited learners: medical, nursing, bachelor of health
science, and chaplaincy students
•
Results: All students met learning objectives based on
qualitative analysis of written assignments and highly rated by
participants
Brajtman S, Hall P, and Barnes P. Enhancing interprofessional education in endof-life care: an interdisciplinary exploration of death and dying in literature. J
Palliat Care. 2009 Summer; 25(2): 125-31
Past IPE Palliative Care Workshops
Interdisciplinary education in end-of-life care: Creating
new opportunities for social work, nursing, and clinical
pastoral education students
• Description: Interprofessional case simulations with volunteer
actors
• Recruited learners: Social work, nursing, and chaplain students
• Results: All students found it valuable and most cohorts
demonstrated significant improvement in pre-determined
outcomes
Forrest C and Derrick C. Interdisciplinary education in end-of-life care: creating
new opportunities for social work, nursing, and clinical pastoral education
students. J Soc Work End Life Palliat Care. 2010; 6(1-2): 91-116.
Past IPE Palliative Care Workshops
Using Online Learning and Interactive Simulation To
Teach Spiritual and Cultural Aspects of Palliative
Care to Interprofessional Students
• Description: Combined online learning with interactive
simulation
• Recruited learners: Social work, nursing, medicine, and
chaplain
• Results: Successfully met five learning objectives and
highly rated by participants
Ellman MS, Schulman-Green D, Bratt L, et al. Using Online Learning and
Interactive Simulation to Teach Spiritual and Cultural Aspects of Palliative Care to
Interprofessional Students. J Palliat Med. 2012; 15(11); 1240-
Past IPE Palliative Care Workshops
Effect of Communication Skills Training for Residents and
Nurse Practitioners on Quality of Communication With
Patients with Serious Illness: A Randomized Trial
•
Description: Randomized participants to 8-session, simulationbased, communication skills intervention vs usual education
•
Recruited learners: Medicine, nurse practitioners
•
Results: Simulation-based communication training did NOT
improve quality of communication but was associated with
small increase in patients’ depressive symptoms
Curtis JR, Back AL Ford DW et al. Effect of Communication Skills Training for
Residents and Nurse Practitioners on Quality of Communication with Patients
with Serious Illness: A Randomized Trial. JAMA. 2013 Dec 4; 310 (21): 2271-81
Overall Conclusions
• IPE is generally well received by students
• Number of disciplines in workshops ranged
from two to five
• Simulation-based training did NOT translate
into improved quality of communication
Overview
• IPE Background
• IPE and palliative care
• WORKSHOP HISTORY
• Workshop description
• Results
• Study limitations
• Future implications
Workshop History
2011-2012
• Piloted first interprofessional, communication workshop
with advanced practice nursing students and physician
fellows
• Developed as three-station palliative care Observed
Structured Clinical Examination (OSCEs)
Corcoran AM, Lysaght S, Lamarra D, Ersek M. Pilot test of a three-station
palliative care observed structured clinical examination for multidisciplinary
trainees. J Nurs Educ. 2013 May;52(5):294-8.
Workshop History
2012-2013
• Expanded workshop to include learners from nursing
(undergraduate and advanced practice), medicine (fellows),
physical therapy, occupational therapy, pharmacy,
chaplaincy, and social work (masters students)
• Recruited learners from BOTH University of Pennsylvania
and University of Sciences
• Demonstrated statistically significant improvement in
learner preparedness for interprofessional team and
communication skills
Lessons Learned from Past
Workshops
Learners appreciated the opportunity to work in
interdisciplinary teams
Rated the topic as good to excellent
Learners need to be matched based on training
level
• i.e. Physician fellows are not well matched with
undergraduate nursing students
Overview
• IPE Background
• IPE and palliative care
• Workshop history
• WORKSHOP DESCRIPTION
• Results
• Study limitations
• Future implications
Workshop Goals
Introduce palliative care communication and
interprofessional team skills to learners
Determine effectiveness of interprofessional
workshop on improving these self-reported skills
Recruited Learners
University of Pennsylvania
•
•
•
•
Medicine (fourth year medical students)
Social Work
Nursing (undergraduate, advanced practice)
Chaplaincy
University of Sciences
• Physical therapy
• Occupational therapy
• Pharmacy
Key Components of Workshop
Workshop Basics
• Pre-workshop preparation
• Two-hour simulation-based workshops with STANDARDIZED
PATIENTS
• Four sessions offered over two days in October
Participants and Observers
• Nursing and social work students were assigned to be either
participants or observers at the discretion of their faculty
• All participants were assigned to pre-determined
interprofessional teams
Recruited diverse, interprofessional faculty facilitators
Case Description
Patient is a 72 y/o female with dementia admitted
from a nursing home to the ICU three days ago for
aspiration pneumonia. She is now doing better and
transferred to the floor.
At baseline, she requires assistance in her all of her
ADLs. She is noted to have signs of aspiration
Goal of meeting is to discuss goals of care
(resuscitation, discharge plan) with patient’s daughter
or son
Workshop Schedule
4:004:15
4:155:15
5:155:45
Orientation
Participant
group 1
meets with
SP 1
Observer
group 1
observes
Participant Participant Participant
group 2
group 3
group 4
meets with meets with meets with
SP 2
SP 3
SP 4
Observer
group 2
observers
Debrief
Evaluations
Participants were given both pre and postworkshop evaluations
Asked participants to rate their confidence in
multiple domains on 5 point Likert scale
• Communication Skills
• Interprofessional team skills (Based on IPEC competencies)
Overview
• IPE Background
• IPE and palliative care
• Workshop History
• Workshop Description
• RESULTS
• Study limitations
• Future implications
Learner Assignments
Recruited 109
learners
73 assigned to
participant
group
Divided into 16
groups of 4-5
each
36 assigned to
observer group
Divided into 7
groups of 5-6
each
Learner Demographics
Participant
Observer
Total
Female
57 (78%)
35 (97%)
92 (84%)
Male
16 (22%)
1 (3%)
17 (16%)
Caucasian
43 (59%)
29 (81%)
72 (66%)
Asian
20 (27%)
4 (10%)
24 (22%)
African American
5 (7%)
3 (8%)
8 (7%)
Hispanic
2 (3%)
0 (0%)
2 (2%)
Mixed heritage
1 (1%)
0 (0%)
1 (1%)
No answer
2 (3%)
0 (0%)
2 (2%)
27
28
Sex
Race
Age (mean)
Learner Demographics
Participant
Observer
Total
17 (23%)
34 (94%)
51 (47%)
Advanced
16 (22%)
28 (78%)
44 (40%)
Undergrad
1 (1%)
6 (17%)
7 (6%)
PT
15 (21%)
0 (0%)
15 (14%)
Pharmacy
12 (16%)
0 (0%)
12 (11%)
Medicine
11 (15%)
0 (0%)
11 (10%)
Social Work
8 (11%)
2 (5%)
10 (9%)
OT
6 (8 %)
0 (0%)
6 (6%)
Chaplaincy
4 (5%)
0 (0%)
4 (4%)
3.28 (0-13)
3.66 (0-15)
Profession
Nursing
Years Training (mean)
Importance of IPE
Not at all
(1-2)
Somewhat
(3)
Very
(4-5)
How important is communicating with other health care professionals for you to be
effective in your profession?
Participant
70 (96%)
Observer
1 (3%)
34 (94%)
How committed are you to work on interprofessional communication skills during
your training?
Participant
Observer
1 (1%)
1 (1%)
68 (93%)
1 (3%)
34 (94%)
Prior Experience
Yes
No
Don’t Know
Missing
Work with individuals of other professions to create plan of care
Didactic
68 (62%)
29 (27%)
5 (5%)
7 (6%)
Bedside
67 (62%)
31 (28%)
2 (2%)
9 (8%)
Apply knowledge of my profession to appropriately assess and address health care needs
of a patient
Didactic
76 (70%)
15 (14%)
11 (10%)
7 (6%)
Bedside
55 (51%)
34 (31%)
8 (7%)
12 (11)
Explain the role other professionals play in an interprofessional team
Didactic
67 (62%)
29 (27%)
8 (7%)
5 (5%)
Bedside
52 (48%)
39 (36%)
5 (5%)
13 (12%)
Prior Experience
Yes
No
Don’t Know
Missing
Communicate with other healthcare professions, patients and caregivers
Didactic
63 (58%)
31 (28%)
8 (7%)
7 (6%)
Bedside
64 (59%)
32 (29%)
2 (2%)
11 (10%)
Apply relationship-building values and principles of team dynamics to perform
effectively in different team roles to plan and deliver patient/population-centered care
Didactic
60 (55%)
29 (27%)
13 (12%)
7 (6%)
Bedside
49 (45%)
39 (36%)
11 (10%)
10 (9%)
Facilitate and/or participate in a family conference
Didactic
43 (39%)
46 (42%)
11 (10%)
9 (8%)
Bedside
40 (37%)
52 (48%)
6 (6%)
11 (10%)
Comparison of Pre and PostWorkshop Evaluations
Pre-Workshop
Mean Score
Post-Workshop
Mean Score
Sig. (2-tailed)
Work with individuals of other professions to create plan of care
Participant
3.60
4.11
0.000
Observer
3.83
4.00
0.226
Apply knowledge of my profession to appropriately assess and address health care
needs of a patient
Participant
3.55
4.04
0.000
Observer
3.91
4.06
0.282
Explain the role other professionals play in an interprofessional team
Participant
3.38
4.01
0.000
Observer
3.77
4.17
0.017
Comparison of Pre and PostWorkshop Evaluations
Pre-Workshop
Mean Score
Post-Workshop
Mean Score
Sig. (2-tailed)
Communicate with other healthcare professions, patients and caregivers
Participant
3.54
4.11
0.000
Observer
3.69
4.14
0.014
Apply relationship-building values and principles of team dynamics to perform
effectively in different team roles to plan and deliver patient/population-centered
care
Participant
3.48
4.08
0.000
Observer
3.46
4.09
0.002
Facilitate and/or participate in a family conference
Participant
3.21
4.08
0.000
Observer
3.31
3.89
0.001
Curriculum/Workshop Content
Poor-Fair
(1-2)
Good
(3)
Very good –
Excellent (4-5)
Relevance of topic content to my
discipline
4 (4%)
10 (9%)
92 (84%)
Utility of pre-reading
9 (8%)
19 (17%)
77 (71%)
Utility of pre-workshop video
23 (21%)
22 (20%)
55 (50%)
Utility of pre-workshop
profession specific lecture
15 (14%)
20 (18%)
62 (57%)
Workshop Sessions
Poor-Fair
(1-2)
Good
(3)
Very good –
Excellent (4-5)
Usefulness of small group
orientation
14 (13%)
23 (21%)
69 (63%)
Usefulness of communication
exercise with standardized
surrogates
1 (1%)
6 (6%)
98 (90%)
Usefulness of SPs
1 (1%)
3 (3%)
101 (93%)
Effectiveness of small group
faculty facilitators
2 (2%)
4 (4%)
100 (92%)
Usefulness of post exercise
debriefing
1 (1%)
4 (4%)
101 (93%)
Overall Evaluation
Poor-Fair
(1-2)
Good
(3)
Very good –
Excellent (4-5)
Overall, how would you rate the educational quality of the workshop?
Participant
1 (1%)
Observer
Yes
5 (7%)
65 (89%)
6 (17%)
28 (81%)
No
Not sure
Would you be interested in participating in a follow-up session to practice family
meetings?
Participant
60 (82%)
4 (5%)
8 (11%)
Observer
26 (72%)
5 (14%)
5 (14%)
Overall Conclusions
Pre vs Post Workshop Assessments
• Participant Group: Significantly more confident in ALL
domains after the workshop
• Observer Group: Significantly more confident in most
domains after the workshop
Majority of participants rated the workshop as very good to
excellent
Majority of participants would be interested in participating in
another workshop
Overview
• IPE Background
• IPE and palliative care
• Workshop History
• Workshop Description
• Results
• STUDY LIMITATIONS
• Future Directions
Study Limitations
Variability in student representation
Evaluations Used
• Used non-validated survey tool
• Evaluation of effectiveness was limited to students’
self-reports and did not assess higher level learning
outcomes as acquisition of knowledge or behavior
change
Overview
• IPE Background
• IPE and palliative care
• Workshop History
• Workshop Description
• Results
• Study Limitations
• FUTURE DIRECTIONS
Future Directions
Workshop Structure
• Offer workshop multiple times during the year
• Offer workshop multiple times for the same group of
learners
Evaluations
• Use validated survey tool
• Create OSCE for learners to test behavior changes
Thank you!
Dr. MaryAnn Foricea
Dr. Cathy Poon
Dr. Christine Bradway
Dr. Lora Packel
Dr. Claudia Pravanta
Dr. Carrie Ann Doherty
John Seman
Dr. Mary Ersek
Eunhae Kim
Dr. Zvi Gellis
Dr. Varleisha Gibbs
Dr. Valerie Cotter
Denise LaMarra
QUESTIONS?