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The Impact of Teaching Prognostication at the End of Life: A Pre-Post Interventional Study. Am J Hosp Palliat Care 2018 Mar;35(3):473-477

Date

07/22/2017

Pubmed ID

28731361

DOI

10.1177/1049909117721697

Scopus ID

2-s2.0-85041625474 (requires institutional sign-in at Scopus site)   2 Citations

Abstract

BACKGROUND: Providing accurate and valid prognostic information significantly influences end-of-life care. Disclosing a poor prognosis can be among the most difficult of physician responsibilities, thus having appropriate knowledge during training is crucial for appropriate prognostication.

OBJECTIVE: To provide internal medicine (IM) house staff with a pre- and posteducational survey to determine their ability to accurately prognosticate 5 common end-stage diseases.

DESIGN: We conducted a pre- and posteducational intervention survey-based study. A preintervention survey was administered to IM postgraduate year 1 (PGY-1) and PGY-2-4 house staff. The survey consisted of case scenarios for 5 common end-stage diseases, containing 1 question on comfort level and 2 on prognostication (totaling 10 points). A 30-minute educational intervention was presented immediately after the initial survey. The same survey was readministered 4 weeks thereafter. An identical survey was administered once to palliative care faculty.

RESULTS: Forty house staff completed pre- and posteducational surveys. Eight palliative care faculty completed the survey. No difference was found between all house staff pre- and postscores (mean 2.70 [1.45] vs 2.78 [1.59], P = .141). There was no significant difference between PGY-1 and PGY-2-4 pretest scores (mean 2.63 [1.71] vs 2.81 [1.42], P = .72). The PGY-2-4 posttest score was significantly greater than PGY-1 posttest score (3.38 [1.58] vs 2.38 [1.58], P = .05). Total house staff posttest score was significantly lower than gold standard palliative care faculty (mean 4.71 [1.98] vs 2.78 [1.59], P = .006).

CONCLUSIONS: Our pre-post intervention survey-based study demonstrates no significant increases in all house staff scores. The PGY-2-4 postintervention scores improved significantly. We speculate the optimal time for prognostication education may be after the PGY-1 year when house staff have had sufficient exposure to common conditions.

Author List

Bear A, Keuter T, Patel JJ

Authors

Alexandria J. Bear MD Assistant Professor in the Medicine department at Medical College of Wisconsin
Jayshil Patel MD Associate Professor in the Medicine department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Clinical Competence
Female
Humans
Internal Medicine
Male
Medical Staff, Hospital
Prognosis
Prospective Studies
Terminal Care