Decoding the Code Status: Can a Palliative Care-Led Curriculum Improve Communications Skills in Critical Care and Emergency Department Clinicians? (FR461A)

Abstract

•Recognize the need for Code Status Discussion training for ICU and ER physicians.•Consider the role of the HPM-practitioner in leading Code Status Discussion training. Communicating effectively with patients/families is an important skill. Palliative care (PC) specialists are often consulted to help with complex communication. In acute settings like the intensive care unit (ICU) and the emergency department (ED) a PC-specialist may not be immediately available, and Code Status Discussions (CSDs) are often required urgently. To evaluate the implementation and efficacy of a newly designed CSD curriculum for ED/ICU clinicians. ED and ICU medical trainees at a single tertiary care center were asked to participate in the CSD curriculum. CSD curriculum featured the NURSE-SPIKES model of delivering bad news and the PULSES model for CSDs. The 2-hour curriculum included lecture, roleplay/feedback, and handouts. Participants were surveyed before, at 30 and 60 days about their CSD comprehension and communication self-efficacy using Bieber’s Questionnaire on the Quality of Physician-Patient Interaction (Cronbach Alpha=0.95). Likert scores were analyzed using Pratt’s modified Wilcoxon signed-rank test. Of 38 medical trainees, N=17 completed the pre-survey. Female=35%; Caucasian=53%, Hispanic=24%, Other=24%; ED=65%, ICU=35%. Of respondents, 82% reported prior contact with PC, and only 47% reported prior PC training. 94% rated CSD-training fairly or extremely important, 35% rated their current training inadequate. N=10 completed 30-/60-day surveys. At 30 days, there was significant improvement in 5/14 self-efficacy metrics (one-tailed, alpha=0.05); at 60 days in 10/14 metrics. Improved areas included: interest in patient’s problems, giving detailed information on illness and options, physician-patient trust, joint decision-making, risks/side effects discussion, understanding patient needs, understanding impact of illness, putting patients at ease, and respecting opinion differences regarding treatment. 83% found the course helpful. A CSD curriculum is a useful tool for developing complex communication skills for ED and ICU physicians.