Prognosis, Communication, and Advance Care Planning in Heart Failure: A Module for Students, Residents, Fellows, and Practicing Clinicians
Introduction The increasing prevalence, high symptom burden, and medical advances that often prolong the advanced phase of heart failure mandate an organized and thoughtful approach to medical decision making. However, many clinicians have difficulty discussing prognosis and goals of care with patie...
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| Format: | Article |
| Language: | English |
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Association of American Medical Colleges
2017-06-01
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| Series: | MedEdPORTAL |
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| Online Access: | http://www.mededportal.org/doi/10.15766/mep_2374-8265.10596 |
| _version_ | 1819021352730886144 |
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| author | April Zehm Charlotta Lindvall Kimberly Parks Kristen Schaefer Eva Chittenden |
| author_facet | April Zehm Charlotta Lindvall Kimberly Parks Kristen Schaefer Eva Chittenden |
| author_sort | April Zehm |
| collection | DOAJ |
| description | Introduction The increasing prevalence, high symptom burden, and medical advances that often prolong the advanced phase of heart failure mandate an organized and thoughtful approach to medical decision making. However, many clinicians have difficulty discussing prognosis and goals of care with patients. Barriers include disease- and therapy-specific prognostication challenges in heart failure and a lack of evidence-based primary palliative care education initiatives. Methods In response, we developed this 45-minute training module, which consists of a case-based small-group session and a communication guide. The curriculum highlights prognostication challenges in heart failure and introduces an illness trajectory-based framework to cue iterative goals of care conversations. Results We piloted this learning module with 46 internal medicine residents and interdisciplinary palliative care fellows in groups of three to 15 and obtained anonymous quantitative and qualitative postsession learner survey data to examine feasibility and acceptability. Trainees 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 most felt they could easily apply these skills to their clinical work. In open-ended feedback, learners said the session gave them a better understanding of the heart failure illness trajectory, an improved framework for discussing goals of care with heart failure patients, and specific language to use when having these discussions. Discussion This module represents a new paradigm for teaching both prognostication and advance care planning in heart failure in which illness trajectory guides timing and content of goals of care conversations. |
| first_indexed | 2024-12-21T04:05:45Z |
| format | Article |
| id | doaj.art-37714544be1948dbaec4c7a29aa66ab8 |
| institution | Directory Open Access Journal |
| issn | 2374-8265 |
| language | English |
| last_indexed | 2024-12-21T04:05:45Z |
| publishDate | 2017-06-01 |
| publisher | Association of American Medical Colleges |
| record_format | Article |
| series | MedEdPORTAL |
| spelling | doaj.art-37714544be1948dbaec4c7a29aa66ab82022-12-21T19:16:36ZengAssociation of American Medical CollegesMedEdPORTAL2374-82652017-06-011310.15766/mep_2374-8265.10596Prognosis, Communication, and Advance Care Planning in Heart Failure: A Module for Students, Residents, Fellows, and Practicing CliniciansApril Zehm0Charlotta Lindvall1Kimberly Parks2Kristen Schaefer3Eva Chittenden4Palliative Care Physician, Division of Palliative Care and Geriatrics, Massachusetts General Hospital; Instructor, Harvard Medical SchoolPalliative Care Physician, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute; Palliative Care Physician, Division of Palliative Care, Brigham and Women's HospitalAdvanced Heart Failure Cardiologist, Director of Ambulatory Cardiology, VA Boston Healthcare System; Assistant Professor, Harvard Medical SchoolPalliative Care Clinical Liaison, Advanced Heart Disease Team, Brigham and Women's Hospital; Professor, Harvard Medical SchoolPalliative Care Physician, Division of Palliative Care and Geriatrics, Massachusetts General Hospital; Instructor, Harvard Medical SchoolIntroduction The increasing prevalence, high symptom burden, and medical advances that often prolong the advanced phase of heart failure mandate an organized and thoughtful approach to medical decision making. However, many clinicians have difficulty discussing prognosis and goals of care with patients. Barriers include disease- and therapy-specific prognostication challenges in heart failure and a lack of evidence-based primary palliative care education initiatives. Methods In response, we developed this 45-minute training module, which consists of a case-based small-group session and a communication guide. The curriculum highlights prognostication challenges in heart failure and introduces an illness trajectory-based framework to cue iterative goals of care conversations. Results We piloted this learning module with 46 internal medicine residents and interdisciplinary palliative care fellows in groups of three to 15 and obtained anonymous quantitative and qualitative postsession learner survey data to examine feasibility and acceptability. Trainees 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 most felt they could easily apply these skills to their clinical work. In open-ended feedback, learners said the session gave them a better understanding of the heart failure illness trajectory, an improved framework for discussing goals of care with heart failure patients, and specific language to use when having these discussions. Discussion This module represents a new paradigm for teaching both prognostication and advance care planning in heart failure in which illness trajectory guides timing and content of goals of care conversations.http://www.mededportal.org/doi/10.15766/mep_2374-8265.10596CommunicationPalliative CareSmall GroupPrognosisHeart FailureCase-Based Learning |
| spellingShingle | April Zehm Charlotta Lindvall Kimberly Parks Kristen Schaefer Eva Chittenden Prognosis, Communication, and Advance Care Planning in Heart Failure: A Module for Students, Residents, Fellows, and Practicing Clinicians MedEdPORTAL Communication Palliative Care Small Group Prognosis Heart Failure Case-Based Learning |
| title | Prognosis, Communication, and Advance Care Planning in Heart Failure: A Module for Students, Residents, Fellows, and Practicing Clinicians |
| title_full | Prognosis, Communication, and Advance Care Planning in Heart Failure: A Module for Students, Residents, Fellows, and Practicing Clinicians |
| title_fullStr | Prognosis, Communication, and Advance Care Planning in Heart Failure: A Module for Students, Residents, Fellows, and Practicing Clinicians |
| title_full_unstemmed | Prognosis, Communication, and Advance Care Planning in Heart Failure: A Module for Students, Residents, Fellows, and Practicing Clinicians |
| title_short | Prognosis, Communication, and Advance Care Planning in Heart Failure: A Module for Students, Residents, Fellows, and Practicing Clinicians |
| title_sort | prognosis communication and advance care planning in heart failure a module for students residents fellows and practicing clinicians |
| topic | Communication Palliative Care Small Group Prognosis Heart Failure Case-Based Learning |
| url | http://www.mededportal.org/doi/10.15766/mep_2374-8265.10596 |
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