Michael D. Barnett

Neonatal Critical Care Communication (NC3): training NICU physicians and nurse practitioners.

Objective:Communicating with families is a core skill for neonatal clinicians, yet formal communication training rarely occurs. This study examined the impact of an intensive interprofessional communication training for neonatology fellows and nurse practitioners.Study Design:Evidence-based, interactive training for common communication challenges in neonatology incorporated didactic sessions, role-plays and reflective exercises. Participants completed surveys before, after, and one month following the training.Result:Five neonatology fellows and eight nurse practitioners participated (n=13). Before the training, participants overall felt somewhat prepared (2.6 on 5 point Likert-type scale) to engage in core communication challenges; afterwards, participants overall felt very well prepared (4.5 on Likert-type scale) (P<0.05). One month later, participants reported frequently practicing the taught skills and felt quite willing to engage in difficult conversations.Conclusion:An intensive communication training program increased neonatology clinicians’ self-perceived competence to face communication challenges which commonly occur, but for which training is rarely provided.

Sudden Advanced Illness An Emerging Concept Among Palliative Care and Surgical Critical Care Physicians

Background: End-of-life discussions in critically-ill patients with acute surgical conditions may be rushed and occur earlier during hospitalization. This study explores the concept of sudden advanced illness (SAI) and its relevance to patients requiring Palliative and Surgical Critical Care. Methods: Semi-structured interviews were completed with 16 physicians, querying each about (1) definitional components, (2) illustrative cases, and (3) comfort with SAI. Analysis was done by grounded theory. Results: SAI was characterized as unforeseen, emerging abruptly and producing devastating injury, often in healthy, younger patients. There is (1) prognostic uncertainty, (2) loss of capacity, and (3) unprepared surrogate decision-making. Cases are emotionally-charged and often personal. Conclusion: The emerging concept of SAI is important for understanding how Palliative Care can enhance care for this subset of patients.

Pediatric Palliative Care Pilot Curriculum: Impact of "Pain Cards" on Resident Education.

Background: Prior research has shown that less than 40% of pediatric program directors believe their graduating residents competent in palliative care. While many curricula have been developed to address this need, few have demonstrated improved comfort and/or knowledge with palliative care principles. The purpose of this study was to test a pocket card educational intervention regarding resident knowledge and comfort with palliative care principles. Methods: Pocket reference cards were created to deliver fundamentals of pediatric palliative care to resident learners; didactics and case studies emphasized principles on the cards. Self-reported comfort and objective knowledge were measured before and after the curriculum among residents. Results: Of 32 post-graduate year 2 (PGY2) residents, 23 (72%) completed the pre-test survey. The post-test was completed by 14 PGY2 residents (44%) and 16 of 39 PGY3/4 residents (41%). There was improvement in comfort with communication, as well as pain and symptom management among the residents. Knowledge of palliative care principles improved in part, with only a few survey questions reaching statistical significance. 100% of respondents recommended the cards be provided to their colleagues. Conclusion: This longitudinal curriculum, designed specifically for pediatric residents, was built into an existing training program and proved to be popular, feasible, and effective at improving comfort with basic palliative care principles.

Communication Education, Modeling, and Protocols Transform Clinicians to Agents of Empowerment

Ubel and colleagues correctly note that communication style, and a lack of clarity in what is being communicated, often lead to ineffective patient empowerment (Ubel, Scherr, and Fagerlin 2017). Fortunately, over the past few decades, increased efforts to rectify these shortcomings have become commonplace. Palliative medicine providers are consistently a key component with these efforts (Levine et al. 2017). Herein, we discuss several communication tools that have been developed for clinicians and are a routine part of palliative medicine practice. [Note. We utilize the term “clinician” throughout, to emphasize that these communication pitfalls are actualized by physicians, advanced practitioners (nurse practitioners, physician assistants), nurses and social workers at the bedside, among other groups. We agree that physicians may ultimately be responsible for promoting activation of autonomy, but communication by all health care providers (clinicians) often needs improvement as well.] The goal of each communication tool is to help clinicians move from what Ubel, Scherr, and Fagerlin (2017) describe as an “ethic of information” to a joint partnership. Therein, discussions begin with and are framed within the context of the patients’ goals and values, as well as those of their families and/or surrogate decision makers. We expect that as palliative care and communication skill practicums become more established in clinical and medical education settings, learned communication tools will transform clinicians’ communication skills which will lead to effective shared decision making among patient–clinician dyads. Protocol-driven or procedural thinking has long been critical within medical pedagogy. Surgical or anatomic interventions are taught with evidence-based technical frameworks, grounded in experience, such as “see one, do one, teach one” (Krautter et al. 2011; Romero et al. 2017). Each stage within these frameworks offers and reinforces an explicit understanding of the procedure’s anatomic, physiologic, and technologic foundation. In contrast, effective communication skills are often not subject to the same rigors of procedural thinking. Nevertheless, this topic has received increased emphasis in modern medical curricula and the efficacy of each strategy has been subject to methodologic inquiry and investigation. As Ubel and colleagues suggest, clinicians have been asked to be good communicators “without being taught how to do so effectively” (2017). Fortunately, this is changing. Several formal communication tools have been developed recently, to train clinicians how to communicatemore effectively. These efforts are led by palliative care specialists but are applicable to a broad interdisciplinary team. The tools move beyond a vague directive to “be empathic” and emphasize the importance of following a protocol or “talking map,” particularly in difficult conversations that involve conflict and end-of-life decision making. Much like learning how to do a procedure, these talkingmaps reinforce skills via a methodical format that helps clinicians stay focused, track essential components of a conversation, and avoid getting lost when complications arise. The map helps identify where to begin with a patient or family and where to go, while eliciting patient-derived values earlier in the conversation. Ideally, these skills are practiced first in lowimpact scenarios such as small groups with other trainees, reinforcing the concepts (i.e., creating “muscle memory”), so

Add Your Voice: Vetting the Entrustable Professional Activities for HPM Physicians (TH335)

1994 to 2003, the PDIA created funding initiatives in professional and public education, the arts, research, clinical care, and public policy that transformed care for patients living with serious illnesses in the United States. Four PDIA Awards will be presented: the AAHPM PDIA Palliative Medicine National Leadership Award, the AAHPM PDIA Palliative Medicine Community Leadership Award, the HPNF PDIA Nursing Leadership Award in Palliative Care, and the SWPHN PDIA Career Achievement Award. Award recipients will participate in panel presentations on topics such as career trajectory, lessons learned, and take-away ‘‘pearls’’ for the attendees.

Challenges and Opportunities in Caring for Children in a Primarily Adult Hospice (SA504)

An elderly wife and mother dying of end-stage cardiomyopathy who experienced significant distress about her dying process. Her acute dying process was prolonged, and her family compellingly requested help from the palliative care team with hastening her death. Using an interactive format with audience participation and discussion, we will discuss the pearls learned from our ‘‘bucket list’’ patients and briefly review supporting evidence.