MRS REBECCA JOHNSTON1, Ms DRAGANA ZEKANOVIC1, Ms SHARYN MILNES2, Dr NEIL ORFORD2, Dr ANGELA MAKRIS1
1Department of Nephrology, South West Sydney Local Health District, Liverpool, NSW 3, Liverpool , Australia, 2ICU Barwon Health Barwon Health, Geelong, Victoria, Geelong, Australia
Background
Shared decision-making is important for people with chronic medical disorders. Advance care planning (ACP) improves end-of-life outcomes for renal patients and is cost effective.
Aim
Understand the impact of clinicians undertaking a medical communication course on their self-reported confidence of shared-decision making and ACP and impacts on health system outcomes.
Methods
We provided a commercial medical three-session experiential small-group communication program (iValidate) to renal clinicians at SWSLHD. Clinicians undertook surveys self-assessing their competency and the program at four time-points – immediately after, 1 week, 2 and 6 months after the program. The impact on patient care was assessed by measuring palliative care referrals, number and route of admissions, ACPs, medical emergency team (MET) reviews and intensive care unit (ICU) admissions in a prevalent dialysis population for 6 months before and after the program. Analysis was undertaken with SPSS.
Results
Of the 24 participants that registered 8 were nursing/allied health and 16 medical. All advanced trainees and 72% of senior medical staff attended. Participants reported an improvement in confidence in initiating ACP conversations, eliciting patient’s goals, shared decision making and initiating difficult decisions (all p<0.01). After course participation a reduction in referrals to palliative care service (adjusted odds ratio) aOR 0.2(95%CI 0.05-0.74, p=0.016) and ICU admissions (aOR 0.43(95% CI 0.2-0.9) was observed. There was no difference in documentation of ACPs, admission number or route, or number of METs.
Conclusions
A medical communication course improved self-reported confidence in undertaking difficult decisions and engaging in shared decision making in renal clinicians. This was associated with a reduction in referrals to the palliative care service and number of ICU admissions, suggesting increased clinician engagement in end of life decision-making.
Biography:
Rebecca is a clinical nurse consultant and has been working in Renal Supportive Care in NSW since the model of care was rolled out in 2016. With 16 years experience in renal medicine she has always had a passion for improving end of life care for people with renal disease. Rebecca has contributed to the development of renal / palliative care pathways and resources in the Northern Territory as well as NSW.