Abstract
Background:
Primary care clinicians care for most persons with Alzheimer's disease and related dementias (ADRDs), yet lack dementia-specific skills in advance care planning (ACP).
Objectives:
To develop and evaluate a training toolkit for primary care clinicians to improve ACP communication for people with ADRD and their families.
Design:
Clinical practice outcomes assessment and preโpost-training evaluation. Intervention training toolkit addressed ACP skills by dementia stage: (1) advance directives in early dementia, (2) decision-making capacity in moderate dementia, (3) Physician Orders for Life-Sustaining Treatment (POLST) in late-stage dementia, and (4) hospice and hospitalization in advanced dementia.
Setting/Subjects:
Nonhospitalized clinical care sites, 51 clinicians in North Carolina, USA.
Measurements:
Data collection utilized structured chart abstractions and pre- and post-training surveys.
Results:
Of 51 participants trained, 33 had encounters with patients with ADRD in study period. Most participants were women (nโ=โ42), white (nโ=โ37), and physicians (nโ=โ31). Participants increased documentation of surrogates (22.7% vs. 35.5%, pโ=โ0.03), decision-making capacity (13.5% vs.23.2%, pโ=โ0.04), and POLST completion (9.2% vs. 18.8%, pโ=โ0.03). Training increased ACP documentation (6.4% vs. 14.5%, pโ=โ0.031) and goals of care (GOC) decision-making discussions (17.0% vs. 31.9%, pโ=โ0.005). In preโpost-comparisons, participant confidence increased in determining capacity, exploring dementia prognosis, GOC, eliciting surrogates, and leading family meetings (all pโ<โ0.001). Most participants strongly agreed that the training addressed skills used in practice (nโ=โ34), contained clear language (nโ=โ40), took an appropriate amount of time (nโ=โ32), and was designed effectively (nโ=โ35).
Conclusion:
This video-based training resource increased the use of dementia-specific ACP communication skills and clinician confidence.
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