ISQUA16-2772FORETHOUGHT ON THE END OF LIFE: USING SIMULATION TO IMPROVE COMMUNICATION SKILLS WITH END-OF-LIFE PATIENTS AND THEIR FAMILIES IN HOSPITALS OF CLALIT HEALTH SERVICES

Abstract

Objectives: Healthcare facing end-of-life (EOL) raises challenges of overuse of invasive technology, underuse of palliation, suffering of patients and families, serious dilemmas, conflicts and heavy costs. Studies show the feasibility of training residents to handle these challenges with improved communication skills. An intervention was designed to promote quality of EOL care in a large healthcare organization, by training physicians and nurses to improved knowledge and communication skills. Methods: An ongoing program was initiated in June 2012 in the 10 hospitals of Clalit Health Services. We developed a one-day workshop for team members, including physicians, nurses from departments of internal medicine, geriatrics, dialysis and general intensive care. The training used simulation with actors on EOL scenarios followed by debriefing group discussions, constructive feedback and an opportunity to explore challenges for optimal EOL care. Surveys evaluated knowledge and attitudes of participants: before, immediately after and several months after workshops. Results: A total of 909 physicians and nurses participated in workshops. Most participants reported significant improvement in communication skills, knowledge and self-efficacy for EOL care. Participants expressed greater ease in discussing preferences for EOL care with patients and families, in supporting them in decision-making, and in providing palliative care. At the end of the workshop, 93% of the respondents stated that they plan to initiate more talks with patients and families, and 87% expressed that they will handle such talks differently than they had in the past. At simulations, it became apparent that to avoid the emotional burden of death, physicians engage in cognitive talk about physiological changes of dying, final diagnostic categories, biomedical options and legal issues - neglecting the affective needs of patients and families. Discussions and feedback emphasized that satisfaction is higher when care providers talk less and listen more - stressing the value of silent presence, active listening body language and emotional intelligence rather than cognitive skills. Facing dilemmas and conflicts, the process of decision-making appears more important than the decisions reached, with respect and support to relatives and team members holding different views. For the participants, the workshop may help reduce burnout and enhance personal growth and professional fulfillment. At a late survey, most respondents reported improved handling of EOL challenges. Conclusion: Simulation training of healthcare providers appears to be a valuable tool to improve EOL care. Implementation of this intervention in all hospitals of our organization seems to have a positive effect on organizational culture.