Improving Pediatric Residents' Comfort and Facility with End-of-Life Care with a Just-In-Time Online Module

Improving Pediatric Residents' Comfort and Facility with End-of-Life Care with a Just-In-Time Online Module

Jenkins R; Nicholson A; Ernest EP; Foreman K; Cicozi K; Humphrey LH

Journal of Pain and Symptom Management

2024

child; terminal care; controlled study; human; palliative therapy; total quality management; follow up; comfort; Likert scale; conference abstract; simulation; workflow; knowledge base

Outcomes: 1. Participants will be able to learn how a just-in-time module can be constructed to address both resident needs and palliative care teaching goals. 2. Participants will be able to describe different ways in which a just-in-time module can improve residents' experience with the provision of end-of-life care. Key Message: Patient death is a difficult event experienced by most pediatrics residents. While relatively rare, learners feel unprepared and find it challenging to do this work, but must be prepared for it. We designed a novel online just-in-time module designed to improve pediatric resident education and comfort with end-of-life care and death. Introduction/Context: Though death is relatively rare in pediatric training, most trainees will care for children who require end-of-life care. Residents often report lacking sufficient comfort and experience with end-of-life care. Efforts to improve resident education in palliative care are important in addressing this need. Objective(s): Increase resident comfort and facility with end-of-life care by one standard deviation of scores and sustain for one academic year. Method(s): We created and distributed a survey to evaluate pediatric residents' baseline comfort and facility with end-of-life care at our institution. We then built an online module designed to be a quick accessible just-in-time primer on practical elements of providing end-of-life care, pronouncement, and hospital workflow logistics. A QR code linking to the module was posted in every resident workroom. Residents involved with patient deaths on the floor after module distribution were given a follow-up survey to assess their feelings and knowledge base following each event. Data collection began in January 2023 and is ongoing. Result(s): Baseline data was collected from 96 respondents of a total class of 163 (59%). Twenty-two residents have since participated in a death on the floor, of which 9 completed our follow-up survey (41%). Scores across respondents were averaged at baseline and per event. Comfort, measured by Likert scale 1-7, increased from baseline 4.0 to median 5.0. Facility, measured by correct score on a knowledge test, increased from baseline 50% to median 69%. Neither measure achieved the goal of a full standard deviation increase (5.78 and 75%, respectively). Conclusion(s): Our module shows a trend towards improvement in comfort and knowledge regarding end-of-life care for pediatric residents, though with room for further improvement and to address other identified needs. Subsequent PDSA cycles will expand content and incorporate simulation to further trainee comfort and knowledge of pediatric death. Keywords: Quality Improvement; Workforce / Career DevelopmentCopyright © 2024

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