A WISH TO DIE AND THE OLDER ADULT: THE IMPACT OF BESPOKING ON VIRTUAL CONTINUING EDUCATION

Abstract

Introduction Older adults with depression or chronic illness may express a wish to die. Front-line healthcare professionals may be clinically tasked with the challenging scenario of distinguishing whether a patient is depressed, suicidal and/or requesting a medically assisted death (MAID), a procedure recently legalized in Canada. Baycrest, a large academic geriatric health centre in Toronto, offers virtual interactive learning through modules and webinars, which have been shared nationally with healthcare professionals interested in geriatric mental health. Our mandate is to create continuing education that engages learners and optimizes learning outcomes. In our most recent module, “A Wish to Die: MAID, Depression and the Older Adult”, we introduced the process of customization or bespoking and examined the impact on learning of this novel educational methodology. Methods 1) Bespoking A free learning event, “Depression, MAID and the Older Adult” was advertised through national memberships and databases of Canadian healthcare professionals working in the area of seniors' mental health. Through SurveyMonkey, participants were asked to choose the nature of the case (acute care vs. community vs. long-term care) and other components that could be individualized and customized. A small group of registrants was not bespoked and comprised the comparison group. 2) Virtual Blended Learning An interactive online module was made available for 2 weeks and was followed 1 week later by a live, facilitated webinar to consolidate learning. 3) Evaluation Knowledge and comfort in working with older adults who express a wish to die were assessed pre-module and post-webinar. Impact and change in practice (e.g., use of a new tool) were assessed at 6 weeks post-webinar. The data were summarized using descriptive statistics, including Fisher's exact tests to compare groups, and longitudinal logistic regression with random intercepts. All analyses were done using SAS version 9.4. Results The proportion of participants with an approach to working with older adults who express a wish to die significantly increased from 22% (pre, N=27) to 63% (post, N=27, p=0.003) and non-significantly increased from post to 86% at follow up (N=22, p=0.08) for the Bespoke group (Figure 1). The non-Bespoke group significantly increased from 28% (pre, N=36) to 72% (post, N=36, p=0.0003) but then non-significantly decreased from post to 58% at follow up (N=19, p=0.32). There was no significant group difference in the change in proportions from pre to post (p=0.85) but the change in proportions from post to follow up was significantly greater for the Bespoke group compared to the non-Bespoke group (p=0.05). At follow up, the Bespoke group had a larger proportion with an approach to working with an older adult who expresses a wish to die, but it was not significant (86% versus 58%, p=0.08). At 6 weeks post-webinar, ∼89% (N=45, all participants) reported participation in the learning activity had a positive impact on their practice. ∼72% indicated that participation had helped with client/patient care (N=43). 93% (N=27, Bespoke group) wanted more bespoke education opportunities. Conclusions A large majority of study participants responded that the learning activity had a positive impact on their practice and helped with patient care. Interest in further bespoke learning opportunities was high. Learning outcomes were similar between groups with a positive trend for bespoked participants to identify having an approach to an expressed wish to die after the intervention. Bespoking is easy to implement, appears to contribute to engagement and through virtual technology, can target the needs of multiple learners simultaneously. Incorporating customization into the development of an online learning module was an effective means for transmitting knowledge about a clinical approach to an older adult who expresses a wish to die. The utility and feasibility of using bespoke methodology in continuing education merits study in other subject areas, both within geriatric psychiatry and more broadly, with larger sample sizes. This research was funded by This project was funded by the Ontario Ministry of Health and Long-term Care Academic Health Sciences Centres Alternate Funding Plan Innovation Fund.