Healthcare professionals’ intention to engage in serious illness conversations after team-based versus individual-based training in advanced care planning: secondary analysis of a cluster randomized clinical trial

Introduction:

In advance care planning (ACP), healthcare professionals (HCPs) discuss end-of-life decisions with patients and their families in respect for their wishes and autonomy. Very few studies have evaluated the impact of ACP in primary care, and none  evaluated the involvement of primary care HCPs in ACP. 

Objective:

To compare the impact of interprofessional team-based training versus individual clinician-based training on healthcare professionals’ intention to engage in ACP discussions.

Methods:

This study is a secondary analysis of a cluster randomized trial. HCPs from 41 primary care clinics in the United States and Canada were recruited. Primary care clinics were randomly assigned to either interprofessional team-based training (intervention) or individual clinician-based training (control). Both trainings were adapted from the Serious Illness Care Program developed by Ariadne Labs and lasted 3 hours (1.5h online tutorial and 1.5h in-person role-play session). After training, participants were asked to complete CPD-Reaction, a self-administered validated questionnaire to rate effectiveness of continuing professional education activities, to measure their intention to have ACP discussions with their patients. Sociodemographic data were collected. A descriptive analysis is being performed and a linear mixed model will compare HCP intentions between study arms. 

Results:

534 participants were recruited. 326 completed the interprofessional team-based training and 208 completed the individual clinician-based training. Preliminary analyses are ongoing and results will be available in May 2022.

Discussion:

Considering that an interprofessional approach facilitates the discussion of a complex subject using the knowledge of professionals from different disciplines, the main hypothesis of the study is that an interprofessional training approach will increase HCPs’ intention to have end-of-life care conversations with their patients, thus increasing the use of ACP in primary care. Taking into account that ACP reinforces shared decision making, there would be an increase in patient autonomy and satisfaction and improved quality of care.