Optimizing Advance Care Planning education for elderly care physicians in training

Relevance

In long-term care for older people, advance care planning holds paramount importance in ensuring appropriate and personalized care. It encompasses an ongoing and dynamic process of conversations about life goals and preferences regarding future treatment and care. In 2022, the Dutch Foundation for Long-Term Care Quality Impulse (SKILZ) conducted a bottleneck analysis that identified challenges in advance care planning within long-term care. Despite advance care planning being one of the cornerstones of elderly care medicine, the analysis revealed a need for improving skills and collaboration among elderly care physicians (ECP). By optimizing the training program for ECPs, all future ECPs will be equipped with the necessary competencies in advance care planning.

Objectives

ECP trainees develop the necessary competencies for providing timely, structured, and person-centered advance care planning to patients and families, in collaboration with the interprofessional team. To this end, an innovative education program on advance care planning will be developed and will be implemented in the program of the Dutch ECP training institutes.

Research design

This action research is initiated by Maastricht University. It will be conducted in collaboration with 3 other ECP training institutes and long-term care facilities. The research consists of several spirals of action:

1. To get insight in the preferences of patients and loves ones regarding advance care planning in long-term care for older people based on available literature and existing research data, supplemented with new qualitative individual interviews with patients in long-term care and relatives.
2. To create an overview of the required competencies of ECP for providing advance care planning in interprofessional collaboration based on available research data, supplemented with new focus group interviews with professional caregivers in long-term care.
3. To identify learning needs of trainees and changes therein using focus group interviews with trainees, university teachers and trainee supervisors.
4. To develop an innovative teaching program on advance care planning with experts in the field of medical education in cocreation with stakeholders.
5. To evaluate and optimize the teaching program through an iterative process.
6. To develop an educational module for trainee supervisors.

Participants

This study will be conducted in collaboration with patients receiving long-term care, their loved ones, patient representatives, trainees, ECPs, teachers, trainee supervisors and other long-term care professionals (including nurses, spiritual caregivers, psychologists, social workers, and other healthcare professionals) and educationalists. The aim is to include participants from different cultural and religious backgrounds, gender and age.

Intended results

The project will result in an innovative teaching program on advance care planning for ECP trainees, aimed at providing timely and person-centered advance care planning to patients and loves ones in collaboration with an interprofessional team. A module on advance care planning will be developed for trainee supervisors to support them in optimizing the workplace learning of the trainees. Furthermore, a plan will be created to safeguard and update the developed education, in conjunction with the five Dutch ECP training institutes. Finally, the optimized education will be implemented.

Impact

The developed teaching program, consisting of learning tasks, will be available for all Dutch ECP training institutes. This research project contributes to the expansion of knowledge crucial for optimizing interprofessional advance care planning. The project provides insights into the utilization of innovative teaching methods in advance care planning training for other professionals. The learning tasks developed will also have relevance to training programs, such as for family medicine and other medical specialties.