Honoring Veterans’ Wishes: Efficacy of an Evidence-Based Shared Decision-Making Tool

Outcomes 1. By the end of the presentation, the learner will identify an evidence-based standardized tool for facilitating goals-of-care discussions. 2. By the end of the presentation, the learner will identify a method of evaluating ICU intern/resident knowledge and confidence in facilitating goals of care discussions. Key Message Educating providers on facilitating GOC discussions can lead to improvement in provider knowledge and confidence with shared decision-making, improve communication regarding veterans' end-of-life wishes, reduce the frequency of futile medical interventions, and preserve the autonomy of critically ill veterans. Introduction Effective goals-of-care (GOC) discussions are key ingredients of quality healthcare delivery. Not only can they limit futile and costly medical interventions, but they also support patient well-being and autonomy during critical and vulnerable life transitions (1,2,3,4). However, this shared decision-making process can be a challenging endeavor. Literature shows that clinicians caring for patients with serious medical illnesses (SMI) in hospital settings often report feeling ill-equipped to facilitate GOC discussions (5,6,7). Subsequently, these discussions are frequently delayed, avoided, or navigated in ways that don't clearly communicate the patient's wishes (2). Objectives This project aims to improve San Diego VA Intensive Care Unit (ICU) clinicians' knowledge and confidence in facilitating GOC discussions and their documentation (7,8,9,10). Methods Three separate education sessions will be provided to ICU medical residents/interns, registered nurses, chaplains, and social workers on an evidence-based standardized tool (EBST) for initiating GOC discussions (11,12,13). Pre- and post-implementation surveys were administered to the residents/interns to assess provider knowledge and confidence with GOC discussions (14). Trained ICU residents/interns used the EBST with every patient admitted to the ICU as part of their history & physical and documented the GOC discussion in the electronic health record (EHR). Results All VA ICU residents/interns on three separate rotations and >50% of ICU RNs will receive training and practice on the EBST. On-going data collection: - Pre- and post-implementation survey data on clinician knowledge and confidence with GOC discussions - Three months before and after EBST training GOC documentation in the EHR Conclusion Educating providers on using an EBST for facilitating GOC discussions can improve provider knowledge and confidence with shared decision-making and improve communication regarding veterans' end-of-life wishes (5,6,7,9,10,12,13). Keywords Shared Decision Making / Advance Care PlanningQuality Improvement