Background Making clinical decisions when recovery is uncertain can be challenging for clinicians working within the acute hospital. Recognising the possibility of uncertain recovery facilitates honest and sensitive conversations about patients wishes, values and preferences, enabling clear plans to be developed which guide future decision making.
Method In a collaborative project between Specialist Palliative Care, the Emergency Department and Frailty, an interactive workshop, ‘Critical Decision Making in Clinical Uncertainty’ was developed to enable experienced clinicians to explore the clinical, communication, legal and ethical considerations of caring for patients where prognosis is limited and recovery uncertain. The role of Treatment Escalation Plans (TEPS), Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) and Anticipatory Clinical Management Plans are explored, using clinical cases, and staff given the opportunity to reflect on their own practice with colleagues.
Results Training has been delivered to 34 senior clinicians (19 hospital doctors, 1 GP, 14 senior nurses/ANPs) resulting in lively, interdisciplinary discussions and a sharing of knowledge and experience. The sessions were well evaluated (mean 9.3/10) and staff valued the interactive nature of the workshop, recommending it to colleagues.
Pre- and Post-course confidence levels showed improvement: confidence to have an open and sensitive conversation with a dying person (7.5/10 to 9/10), confidence to develop a TEP (4/10 to 6/10), confidence to make decisions regarding CPR (4/10 to6/10) confidence to develop an ACMP (5/10 to 8.5/10).
Conclusion This training stimulated inter-disciplinary discussions about the clinical components of future care planning. Clinicians were able to identify how they could apply learning to their own practice and reflect upon how they document conversations, decisions, and treatment escalation plans, as they ‘pass the baton of care’ to the next clinician caring for their patient.
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