The Impact of Provider Beliefs, Perceptions and Practices on Advance Care Planning Conversations in Seriously Ill Patients

For clinicians, discussions that focus on life-sustaining procedures and interventions is often easier than partaking in conversations that provoke feelings of inadequacy or uncertainty. This may result in patient-provider miscommunication about end of life preferences and goals of care. The focus of this translational research and clinical project was to examine provider barriers to practice and to implement a structured communication tool using the Serious Illness Conversation Guide when engaging patients and family in advance care planning and goals of care discussions. Previous research has indicated that many clinicians lack formal education and confidence in end of life care discussions. The project consisted of a pre- and post-education survey assessing perceptions, beliefs and practices and a virtual training session that included instruction on the use of the Serious Illness Conversation Guide. Participants included physicians, nurse practitioners and physician assistants in hospitalist and other clinical practice settings. Results demonstrated continued confusion as to who should initiate end of life care conversations, with most participants suggesting patients rather than providers initiate discussions. The findings of this study were consistent with previous literature and support the need for structured education for both physicians and nurse practitioners in advance care planning conversations