Conducting Perioperative Code Status and Goals of Care Discussions: A Bi-Institutional Study to Develop a Novel, Evidence-Based Curriculum for Anesthesiology Trainees

NCT04045886 | Completed

• 1 other identifier: 2015P001375
• Study Type: interventional
• Target: 65
• Locations: 1 country
• Sites: 1

Brief Summary

Despite the importance of preoperative code status and goals of care discussion (CSD/GOCD), a formal curriculum for anesthesiology residents is lacking. Residents are often uncomfortable conducting these conversations and there is a lack of research investigating the effectiveness of formal, evidence-based teaching during anesthesia training. The investigators propose to develop a novel skills training program with the aims to assess its immediate effect on CSD/GOCD skills, long-term internalization of the CSD training, and the authenticity, feasibility and acceptability of the CSD program and observed standardized patient encounter (OSCE) interaction. In this prospective, randomized study, first year anesthesia residents will be assigned to the study or control group. Both groups will undergo pre- and post-intervention OSCEs. The control group will complete the online modules only, while the study group will complete the entire skills training program consisting of online modules, self-assessments, and small group exercises. To measure CSD/GOCD proficiency, all participants will interview trained patient actors in pre-and post intervention OSCE. Investigators will use existing scoring systems and surveys. Standard patient encounters will be video recorded and reviewed by two blinded clinician graders. The pre- and post-participation survey will assess comfort and experience with CSD/GOCD. The follow up surveys will assess long-term retention of training, comfort and interim experiences. Investigators will perform a validation of the existing CSD/GOCD assessment tools for use in the perioperative setting. If there is a clinically significant demonstrable benefit, investigators expect that the results will lead to a formalization of this innovative curriculum on a national scale.

Conditions

Shared Decision Making; End of Life

Outcome Measures

Primary Outcomes (1)

• Performance on the assessment/scoring tool.

  Assessment tool was designed by the investigators for this study. The scoring tool measures conversation/communication skills based on 4 domains: general patient interviewing skills, discussing goals of care, discussing code status, and responding to emotion. The observed scale is 1-5 (low to high) for each domain. Scores will be then added for all domains to come up with a final score (possible range 4-20). Better values represent a better outcome.

  1 week, includes evaluation during the OSCE examination, including both pre and post intervention OSCE

Study Arms (2)

Online Educational Modules group

EXPERIMENTAL

anesthesia residents are randomized to watch educational videos which is the intervention.

Behavioral: Online Educational Modules (Videos)

Reading two research papers group

ACTIVE COMPARATOR

anesthesia residents are randomized to read 2 research papers which is the active comparator

Behavioral: Online Educational Modules (Videos)

Interventions

Online Educational Modules (Videos) BEHAVIORAL

5 educational online modules (videos) about DNR/goals of care discussions that the participant will watch as part of the intervention. This is the only intervention.

Online Educational Modules group; Reading two research papers group

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Current Anesthesiology Resident at the Brigham and Women's Hospital

You may not qualify if:

• Not a current anesthesiology resident
• Prior study participation
• Unable to complete both OSCEs during a 1 week rotation

Sponsors & Collaborators

• Brigham and Women's Hospital: lead
• Vanderbilt University: collaborator

Study Sites (1)

Brigham and Women's Hospital

Boston, Massachusetts, 02115, United States

Location

MeSH Terms

Conditions

Death

Interventions

Videotape Recording

Condition Hierarchy (Ancestors)

Pathologic Processes; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Tape Recording; Audiovisual Aids; Educational Technology; Technology; Technology, Industry, and Agriculture; Television

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: TRIPLE
• Who Masked: PARTICIPANT, INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: OTHER
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Professor of Anesthesia

Study Record Dates

• First Submitted: November 13, 2017
• First Posted: August 6, 2019
• Study Start: January 1, 2017
• Primary Completion: February 1, 2019
• Study Completion: July 1, 2019
• Last Updated: August 24, 2022

Record last verified: 2022-08

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)