Division of Geriatrics and Palliative Care Medicine, New York-Presbyterian Queens, Flushing, New York, NY.
Department of Psychology, St. John's University, Jamaica, New York, NY.
Palliat Support Care. 2023 Jun;21(3):422-428. doi: 10.1017/S1478951522000232.
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.
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.
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 ( < 0.001), ACP procedural knowledge ( < 0.001), ACP communication/relationships knowledge ( < 0.001), and self-efficacy ( < 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.
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.
临床医生报告在预先医疗指示（ACP）方面存在培训不足的情况，包括对文化/精神因素对患者决策的影响的理解有限，以及在跨学科团队合作方面的技能有限。本研究描述了 Advance Directives-Live Action Simulation Training（AD-LAST），这是一个跨学科的体验式和教学式培训计划，用于讨论 ACP 和临终关怀。AD-LAST 强调了医疗决策中的文化/精神差异。
前瞻性教育队列研究，干预前后进行调查。AD-LAST 结合了 ACP/EOL 沟通的教学和体验式培训的标准课程工具。该研究在纽约皇后区的一家城市教学医院进行，该医院是美国最多样化的县之一。参与者包括医生、住院医师、护士、治疗师和其他学科。AD-LAST 的形式是为期一天的研讨会。上午专注于使用广泛可用的课程工具进行教学。下午则涉及使用标准化患者演员进行体验式练习。干预前后的问卷评估了 ACP 操作知识和自我效能（即对 ACP 和 EOL 沟通技能的自信）的变化。重复测量方差分析评估了从预测试到后测试在知识和自我效能方面的变化。
2015 年 8 月至 2019 年 1 月期间，共有 163 名临床工作人员参加了 21 次 AD-LAST 培训课程。与前测相比，参与者在总知识（<0.001）、ACP 程序知识（<0.001）、ACP 沟通/关系知识（<0.001）和自我效能（<0.001）方面均有显著提高。知识和自我效能之间没有相关性，代表了独立的结果。方案后评估显示，超过 96%的参与者对 AD-LAST 非常满意，尤其是有机会实时练习技能并从其他专业群体成员那里获得反馈。
AD-LAST 是一种多方面的培训计划，在跨学科环境中实施，可有效提高 ACP 知识和自我效能，包括解决文化/精神问题的能力。标准工具的使用促进了传播。案例模拟的使用加强了学习。
