Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-18T16:19:12.411Z Has data issue: false hasContentIssue false
  • English
  • Français

ACare: A communication training program for shared decision making along a life-limiting illness

Published online by Cambridge University Press:  12 May 2005

JOSEPH S. WEINER  and
STEVEN A. COLE
JOSEPH S. WEINER
Affiliation:
Long Island Jewish Medical Center, New Hyde Park, New York
STEVEN A. COLE
Affiliation:
Stony Brook Health Sciences Center, School of Medicine, Stony Brook, New York
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective: This article describes an innovative 8-h training program that provides clinicians with the competencies necessary to conduct efficient, effective, and compassionate advance care planning discussions throughout the trajectory of life-limiting illnesses.

Method: The Advance Care Training Program (ACare) includes 6 h of group workshops and 2 h of one-on-one faculty–learner interaction. In this article, we describe the (1) objectives of ACare; (2) structure, training procedures, and educational rationale of ACare training; and (3) educational outcome studies in progress.

Results: ACare training in various forms has already been provided to over 100 medical professionals (medical students, medical residents, oncology and geriatric fellows, medical attendings, social workers, and nurses). Formative outcome data indicate considerable trainee satisfaction. Emerging summative outcome data indicate improved skills.

Significance of results: Widespread adoption of the program could increase the frequency and quality of advance care planning discussions between patients with life-limiting illnesses, their health care providers, and families.

Keywords

Advance directivesAdvance care planningPhysician–patient communicationShared decision-makingHealth personnel attitudes
Type
Research Article
Information
Palliative & Supportive Care , Volume 2 , Issue 3 , September 2004 , pp. 231 - 241
Copyright
© 2004 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Bailint, M. (1972). The Doctor, His Patient, and the Illness. New York: International University Press.
Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Reviews, 84, 191–215.Google Scholar
Bandura, A. (1992). Psychological aspects of prognostic judgments. In Prognosis of Neurological Disorders, Evans, R.W., Baskin, D.S. & Yatsu, F.M. (eds.), pp. 13–28. New York: Oxford University Press.
Beck, A.T., Rush, A.J., Shaw, & B.F., et al. (1979). Cognitive Therapy of Depression. New York: The Guilford Press.
Beck, J.S. (1995). Cognitive Therapy: Basics and Beyond. New York: The Guilford Press.
Bird, J., Cohen-Cole, S.A., Boker, & J., et al. (1983). Teaching psychiatry to non-psychiatrists: I. The application of educational methodology. General Hospital Psychiatry, 5, 247–253.Google Scholar
Block, S.D. (2001). Psychological considerations, growth, and transcendence at the end-of-life: The art of the possible. Journal of the American Medical Association, 285, 2898–2905.Google Scholar
Branch, W.T. & Malik, T.K. (1993). Using “windows of opportunities” in brief interviews to understand patients' concerns. Journal of the American Medical Association, 269, 1667–1668.Google Scholar
Breitbart, W. (2002). Spirituality and meaning in supportive care: Spirituality- and meaning-centered group psychotherapy interventions in advanced cancer. Supportive Care in Cancer, 10, 272–280.Google Scholar
Buckman, R. (1992). How to Break Bad News. A Guide for Health Care Professionals, pp. 10–12, 190–198. Baltimore: Johns Hopkins University Press.
Buckman, R. (1996). Talking to patients about cancer: No excuse now for not doing it. British Medical Journal, 313, 699–700.Google Scholar
Byock, I. (1997). Dying Well. Peace and Possibilities at the End of Life. New York: Riverhead Books.
Charles, C., Amiram, G., & Whelan, T. (1999). Decision-making in the physician-patient encounter: Revisiting the shared treatment decision-making model. Social Science and Medicine, 49, 651–661.Google Scholar
Chochinov, H.M., Hack, T., McClement, & S., et al. (2002). Dignity in the terminally ill: A developing empirical model. Social Science and Medicine, 54, 433–443.Google Scholar
Cohen-Cole, S.A. (1980). Training outcomes in liaison psychiatry: Literature review and methodological proposals. General Hospital Psychiatry, 2, 282–288.Google Scholar
Cole, S., Raju, M., Barret, & J., et al. (2000). The MacArthur Foundation Depression Education Program for primary care physicians: Background and rationale. General Hospital Psychiatry, 22, 299–358.Google Scholar
Covinsky, K.E., Fuller, J.D., Yaffe, & K., et al. (2000). Communication and decision-making in seriously ill patients: Findings of the SUPPORT Project. Journal of the American Geriatrics Society, 48, S187–S193.Google Scholar
Crawley, L.M., Marshall, P.A., Lo, & B., et al. (2002). Strategies for culturally effective end-of-life care. Annals of Internal Medicine, 136, 673–679.Google Scholar
Davis, D., O'Brien, M.A., Freemantle, & N., et al. (1999). Impact of formal continuing medical education: Do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes? Journal of the American Medical Association, 282, 867–874.Google Scholar
Elwyn, G., Edwards, A., Kinnersley, & P., et al. (2000). Shared decision making and the concept of equipoise: The competencies of involving patients in healthcare choices. British Journal of General Practice, 50, 892–899.Google Scholar
Emanuel, L., von Gunten, C.F., & Ferris, F.D. (2000). Advance care planning. Archives of Family Medicine, 9, 1181–1187.Google Scholar
Field, M.J., Cassel, & C.K. for the Committee on Care at the End-of-life, Institute of Medicine (1997). Approaching Death: Improving Care at the End-of-Life. Washington, DC: National Academy Press.
Gerrity, M.S., Cole, S.A., Dietrich, & A.J., et al. (1999). Improving the recognition and management of depression: Is there a role for physician education? Journal of Family Practice, 48, 949–957.Google Scholar
Gordon, J., Sanson-Fisher, R., & Saunders, N.A. (1988). Identification of simulated patients by interns in a casualty setting. Medical Education, 22, 533–538.Google Scholar
Gordon, J.H., Walerstein, S.J., & Pollack, S. (1996). The advanced clinical skills program in medical interviewing: A block curriculum for residents in medicine. International Journal of Psychiatry in Medicine, 26, 411–429.Google Scholar
Johnston, S.C., Pfeifer, M.P., & McNutt, R. (1995). The discussion about advance directives: Patient and physician opinions regarding when and how it should be conducted. Archives of Internal Medicine, 155, 1025–1030.Google Scholar
Knowles, M.S. (1973). Self-Directed Learning: A Guide for Learners and Teachers. New York: Association Press.
Knowles, M.S. (1990). The Adult Learner: A Neglected Species, 4th ed. Houston, TX: Gulf.
Kolarik, R.C., Arnold, R.M., Fischer, & G.S., et al. (2002). Objectives for advance care planning. Journal of Palliative Medicine, 5, 697–704.Google Scholar
Larson, D.G. & Tobin, D.R. (2000). End-of-life discussions: Evolving practice and theory. Journal of the American Medical Association, 284, 1573–1578.Google Scholar
Lo, B., Quill, T., & Tulsky, J. (1999). Discussing palliative care with patients. Annals of Internal Medicine, 130, 744–749.Google Scholar
Maguire, P., Fairburn, S., & Fletcher, C. (1986). Consultation skills of young doctors, 1. Benefits of feedback training in interviewing as students persist. British Medical Journal, 292, 1573–1576.Google Scholar
Martin, D.K., Emanuel, L.L., & Singer, P.A. (2000). Planning for the end-of-life. Lancet, 356, 1672–1676.Google Scholar
Novack, D.H. (2000). Use of the self in medical care. In The Medical Interview. The Three-Function Approach, 2nd ed., Cole, S.A. & Bird, J. (eds.), pp. 239–247. St. Louis: Mosby.
Nuland, S.B. (1994). How We Die: Reflections on Life's Final Chapter. New York: Alfred A. Knopf.
Oh, J., Segal, R., Gordon, & J., et al. (2001). Retention and use of patient-centered interviewing skills after intensive training. Academic Medicine, 76, 647–650.Google Scholar
Omnibus Budget Reconciliation Act of 1990. Title IV, Section 4206. Congressional Record. October 26, 1990; 136: H12456–H12457.
Prendergast, T.J. (2001). Advance care planning: Pitfalls, progress, promise. Critical Care Medicine, 29, N34–N39.Google Scholar
Roter, D.L., Hall, J.A., Kern, & D.E., et al. (1995). Improving physicians' interviewing skills and reducing patients' emotional distress: A randomized clinical trial. Archives of Internal Medicine, 155, 1877–1884.Google Scholar
Roter, D.L., Lardon, S., Fischer, & G.S., et al. (2000). Experts practice what they preach: A descriptive study of best and normative practices in end-of-life discussions. Archives of Internal Medicine, 160, 3477–3485.Google Scholar
Suchman, A.L., Markakis, K., Beckman, & H.B., et al. (1997). A model of empathic communication in the medical interview. Journal of the American Medical Association, 277, 678–682.Google Scholar
SUPPORT Principal Investigators for the SUPPORT project. (1995). A controlled trial to improve care for seriously ill hospitalized patients: The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT). Journal of the American Medical Association, 274, 1591–1598.Google Scholar
Teno, J.M. & Lynn, J. (1996). Putting advance-care planning into action. Journal of Clinical Ethics, 7, 205–213.Google Scholar
Tulsky, J.A. & Arnold, R.M. (2002). Communication at the end of life. In Principles and Practice of Palliative Care and Supportive Oncology, 2nd ed., Berger, A.M., Portenoy, R.K. & Weissman, D.E. (eds.), pp. 673–684. Philadelphia: Lippincott Williams & Wilkins.
Weiner, J.S. & Cole, S.A. (2004). Three principles to improve clinician communication for advance care planning: Overcoming emotional, cognitive, and skill barriers. Journal of Palliative Medicine, 7, 817–829.Google Scholar
Weiner, J.S., Cole, S.A., & Roter, D. (2002a). Overcoming physicians' emotional barriers to advance directive communications: An innovative training program for oncology fellows. Research Presentation. Academy of Psychosomatic Medicine Proceedings, 49th Annual Meeting, Tucson, Arizona.
Weiner, J.S., Gordon, J., Walerstein, & S., et al. (2001). Program in the patient–doctor relationship at Long Island Jewish Medical Center: Recipient of the Alan Stoudemire Award for Innovation and Excellence in Consultation-Liaison Education. Poster Presentation, Academy for Psychosomatic Medicine 48th Meeting, 2001, San Antonio, Texas.
Weiner, J.S., Roter, D., & Cole, S.A. (2002b). Training medical oncology fellows in advance directive communications: Focus on physician emotional barriers. Poster Presentation, The American Academy on Physician and Patient, Research and Teaching Forum, Baltimore, Maryland.
Wenrich, M.D., Curtis, J.R., Shannon, & S.E., et al. (2001). Communicating with dying patients within the spectrum of medical care from terminal diagnosis to death. Archives of Internal Medicine, 161, 868–874.Google Scholar