164 - Teaching Providers Serious Illness Communication Skills in Heart Failure

Abstract

Background: The increasing prevalence, high symptom burden, associated co-morbidities and medical advances that often prolong the advanced phase of heart failure (HF) mandate an organized and thoughtful approach to medical decision-making in this population. However, many clinicians have difficulty discussing prognosis and goals of care with patients. Barriers include disease- and therapy-specific prognostication challenges in HF and a lack of evidence-based palliative care education initiatives for HF clinicians. To have effective discussions, providers need advanced training. Purpose: The purpose of this study was to develop and study the effect of a brief clinician educational intervention to review prognostication and teach communication skills along the HF illness trajectory. Methods: A 45-minute training module was developed, which consisted of a case-based small group session and a HF communication guide. The curriculum highlights prognostication challenges in HF and introduces an illness trajectory-based framework to cue iterative goals of care conversations. Specific skills taught include assessing patients' illness understanding and information-sharing preferences, exploring goals and values, making prognostic disclosures, and making medical recommendations for goal-concordant care. We piloted this learning module with 46 CCU-based internal medicine residents and interdisciplinary palliative care fellows in groups of 2–15, and obtained anonymous quantitative and qualitative post-session learner survey data. Results: Clinicians rated the session highly. One hundred percent of learners either strongly agreed or agreed the session was clinically useful. Learners unanimously found the teaching methods effective and the majority felt they could easily apply these skills to their clinical work: 96% felt this session would change or improve their practice. In open-ended feedback solicited, learners said the session gave them a better understanding of the HF illness trajectory, an improved framework for discussing goals of care with HF patients, and specific language to use when having these discussions. Conclusions: A short communication skills teaching session was highly valued by both general and specialty-level clinicians in training. This represents a new paradigm for teaching and learning prognostication and serious illness communication skills in HF, in which illness trajectory guides timing and content of goals of care conversations. This tool can be used to help clinicians who are not trained in palliative care elicit the goals and values of patients with heart failure.