Curriculum Innovation: Combining Didactic and Clinic-Based Methods to Improve Palliative Care Education for Neurology Residents and Advance Practice Providers.

The American Academy of Neurology recognizes a need for neurology clinicians to provide some aspects of palliative care. Palliative care is person-centered and family-centered care that focuses on quality of life for persons living with life-limiting illness. While palliative education programs exist, there is a knowledge gap regarding how to integrate this education into real-world neurology practice. The aim of this study was to improve the perceived knowledge of, comfort with discussing, and frequency of discussing palliative care topics in outpatient neurology practice. Recorded didactic lectures, note templates, and live meetings to discuss real-world challenges were implemented at an academic neurology department and offered to residents and advanced practice providers (APPs). A sample of residents and APPs completed surveys before and 6 months after using this curriculum. Surveys asked questions with Likert responses about their knowledge of, comfort with, and frequency of discussing 7 palliative care topics. A sample of learners and supervising faculty participated in semistructured interviews where authors explored their perceptions about palliative care and this curriculum. Interviews were audiotaped, transcribed verbatim, deidentified, coded, and analyzed. A total of 19 clinicians completed pre-education surveys and 12 completed posteducation surveys. Surveys showed statistically significant improvements overall, including in practical support for patients/care partners, discussing complex symptom management, advance care planning, higher levels of care, and discussing disease course. Overall, 12 interviews were completed, with 4 themes identified: (1) Practical curriculum: the curriculum connected theory to practice; (2) Palliative mindset: the curriculum gave recognition of the suffering of neurologic illness; (3) First, do no harm: clinicians worried about how palliative discussions could harm patients and families; (4) Systemic barriers: neurology clinicians faced systemic barriers in addressing palliative care. Neurology clinicians want to practice palliative care but need ongoing education, sufficient time, clinical availability, and supervisory support to do so. Lectures, note templates, and live meetings to practice palliative care can be implemented feasibly in neurology practice and show preliminary signs of efficacy. Further work is needed to develop and test methods that aim to influence real-world practice.