Assessing the Effectiveness of a Standardized and Concise End-of-Life (EOL) Care Toolkit for Medical Residents in a Teaching Hospital: A Mixed Methods Exploratory Study (Sch409)

ABSTRACT

Outcomes: 1. Assess baseline knowledge, attitudes, and practices on EOL non-pain symptom management among internal medicine residents in a teaching hospital using a cross-sectional survey. 2. Develop a standardized inpatient EOL non-pain symptom management educational toolkit for internal medicine residents. Introduction: With palliative care gaining traction as a vital specialty to help patients living with serious illnesses comes the need for further training of healthcare professionals. Frontline providers such as medical residents can benefit from end-of-life (EOL) care training in symptom management. Method(s) There are three phases (over a period of 4 years) to this study (1) administration of a needs assessment survey of baseline knowledge, attitudes, and practices on EOL non-pain symptom management;(2) development and implementation of a standardized inpatient EOL symptom management toolkit;and (3) a comparison of pre-and postassessment after the educational intervention. Result(s) The baseline survey had 66 participants. There were six non-pain symptoms that were elicited as important for further education and training. These were anorexia, nausea/vomiting, dyspnea, oral secretions, myoclonus, and delirium. Competency-based comfort and confidence levels were assessed using a Likert scale (1-5), with the highest number as the most comfortable. The residents were noted to be more comfortable with EOL communication compared to symptom management. Furthermore, residents who had had previous EOL care experiences with patients were more comfortable in symptom management. The educational intervention implemented at a later time revealed that there was an improvement in posttest scores for EOL symptom management. Discussion(s) This study highlights the needs and gaps in EOL symptom management training for medical residents. The implementation of a standardized inpatient EOL symptom management toolkit might serve as a potential intervention to address the needs and narrow gaps in medical training. This can serve as a possible template for other institutions to integrate an EOL care curriculum in medical residency. Limitations of the study include a small sample size, implementation during the COVID-19 pandemic, variable participant response rate, and interrupted timelines. The next steps include ongoing training for all residents, long-term follow-up postintervention, and institutional buy-in.Copyright © 2023