Coaching Palliative Care Conversations: Evaluating the Impact on Resident Preparedness and Goals of Care Conversations (QI735)

Abstract

1.Describe a novel coaching intervention to improve palliative care skills of resident physicians.2.Identify positive outcomes in resident preparedness and goals of care documentation resulting from palliative care coaching sessions. Lectures alone are likely inadequate to prepare resident physicians for goals of care (GOC) discussions. Drawing on adult learning theories, we developed a real-time, learner-centered coaching intervention to improve palliative care (PC) skills of residents. Evaluate whether short interactive PC didactic and coaching sessions increased resident physicians’ preparedness in discussing PC topics and completion of GOC discussions with hospitalized patients. Prospective quality improvement study involving internal medical residents during their four-week hospitalist rotation at an urban medical center. Two PC physicians led the sessions. Brief didactics trained each three-person resident group in a GOC communication roadmap and appropriate documentation. Informal coaching sessions centered on building skills related to conducting GOC conversations and addressing other PC topics residents raised. Residents completed surveys addressing their level of preparedness on a 5-point scale (from 1 = not well prepared to 5 = very well-prepared) in issues related to discussing GOC pre/post-rotation. We measured GOC documentation in a defined patient population considered “at-risk” by the health system based on age, comorbid conditions, and frequent hospitalizations. We monitored data monthly and made small curricular adjustments during the year. We trained 39 residents over 12 months in thrice-weekly coaching sessions lasting on average 16 minutes. Residents’ level of preparedness increased across several GOC topics. The greatest increases were in eliciting patients’ fears for the end of life (pre/post 3.3/4.1, change +0.8) and helping patients talk with their families about the future (pre/post 3.4/4.2, change +0.8). Documented GOC discussions in at-risk patients increased from 17.4% pre-hospitalization to 53.9% by the end of hospitalization. Resident physicians rated coaching sessions as useful (4.5) and relevant (4.3) to their training. Brief coaching sessions can integrate PC education into a busy clinical service and improve the likelihood that residents will facilitate GOC discussions with hospitalized patients.