7 The Elephant in the Room: An Innovative and Effective Approach to Multidisciplinary Advance Care Planning Training

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Abstract Background Exploring patients’ preferences for future care is known to reduce adverse health outcomes, limit transfers between care settings institutionalisation and improve quality of life. Patients value opportunities to have honest conversations. In the recent “Talking about Dying” report from the Royal College of Physicians (RCP), it was found that healthcare professionals (HCPs) find it challenging to start conversations with patients and families. Yet the report highlights a need for HCPs to be equipped with the skills and confidence to provide opportunities for advance care planning in primary care, inpatient and outpatient settings. Methods A multi-disciplinary faculty delivered simulation sessions to 115 candidates (50.4% doctors, 33% nurses and 16.5% allied health professionals) from primary and secondary care. Eight half-day sessions have taken place across North London. Each session started with an introductory lecture, followed by simulated scenarios between a professional actor and candidate within small multi-disciplinary groups. Group discussion was facilitated and feedback given. We focused on acknowledging the progressive, complex and unpredictable nature of frailty. Scenarios included resuscitation, re-admission to hospital, risk feeding, complex discharge planning and cultural values in older adults. Results 100% would recommend this multidisciplinary simulation to teach advance care planning. Only 15.6% of candidates felt confident or very confident with conversations; this improved to 90.5% following the simulation and was maintained at 69.5% three months later. Understanding when advance care planning is appropriate improved from 70% to 100%. Three months after the training, 86% stated they had a sustained change in practice in ACP as a result of the course. Conclusion We have demonstrated that our multidisciplinary simulation is an effective format of improving understanding and confidence in having advance care planning conversations. These results are evident both immediately after and at the three month follow up stage demonstrating a sustained change in practice.

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