PURPOSE: Research demonstrates that while African Americans support the concept of advance care planning they are less likely to execute advance directives. Our experience at Harlem demonstrates that African Americans are more likely to request aggressive treatments despite an anticipated lack of benefit. Historically, advance directive completion rates are our institution were less than 5%. Bridging the Gap is a project that educates members of the hospital staff to understand the value of advance planning and shared decision making in patient and family-centered care.
METHODS: In 2009, we began to use several approaches to increase house staff knowledge and comfort with advance directives. The topic has been addressed in grand rounds, morbidity and mortality conference and other didactic settings. To supplement the lecture based curriculum, we engaged house staff on a one-on-one basis and sought opportunities to discuss residents’ reactions to patient and family interactions and to encourage self-reflection. In addition, we created a survey instrument adapted from the literature to assess perceived quality of shared decision making and attitudes towards advance directives. We tracked advance directive completion rates and family satisfaction.
RESULTS: Within a 1 year period between January 2010 and December 2010, we noted an increase in ICU patients evaluated by palliative care from 20% to 35%. Percentage of ICU patients with DNR, health care proxy, and advanced directive further increased from baseline respectively (10% to 12%, 28-32%, 35% to 40%). Since we began to measure in December 2010, family satisfaction rates have been between 98-100%.
CONCLUSIONS: In addition to addressing unique environmental and cultural barriers to providing appropriate care that respects patients’ values and beliefs, it is necessary to ensure adequate staff training to bridge the communication gap between patient, families and hospital staff. The value of a directed educational intervention for hospital staff is clear.
CLINICAL IMPLICATIONS: “Bridging the Gap” can potentially reduce the disparities in end of life health care delivery, build trust, and positively impact quality of care.
DISCLOSURE: The following authors have nothing to disclose: Olufemi Lawal, Drew Heyding, Peter Spiro
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