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Residency Training in Advance Care Planning: Can It Be Done in the Outpatient Clinic?

Palliative Care Program, Department of Internal Medicine, University of Oklahoma College of Medicine, Jeffrey-Alderman{at}ouhsc.edu

Baishali Nair, MD

Palliative Care Program, Department of Internal Medicine, University of Oklahoma College of Medicine

Mark D. Fox, MD, PhD, MPH

Section of Medicine/Pediatrics and the Oklahoma Bioethics Center University of Oklahoma College of Medicine, Tulsa, Oklahoma

Resident physicians are expected to assist their outpatients to understand and complete advance directives, but their efficacy in doing so remains uncertain. After receiving educational training, internal medicine residents identified at-risk patients and solicited them about advance directives. Residents completed pretest and posttest questionnaires that assessed their knowledge, skills, attitude, and comfort with advance directives. Patients were also surveyed about their attitudes regarding advance directives. Ten internal medicine residents and 88 patients participated. Residents' self-assessed knowledge rose from 6.0 to 9.2 on a 10-point Likert scale. Skills using advance directives increased from 4.0 to 7.9, attitudes improved from 6.0 to 8.4, and comfort rose from 5.4 to 8.9. Eighty-four percent of patients expressed interest in completing advance directives, and 16% actually completed documents. An educational intervention improved knowledge, skills, attitudes, and comfort with advance directives among internal medicine residents practicing in the outpatient setting. Meanwhile, patients demonstrated a strong interest in completing advance directives.

Key Words: advance directives • resident education • communication

American Journal of Hospice and Palliative Medicine®, Vol. 25, No. 3, 190-194 (2008)
DOI: 10.1177/1049909108315301


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