Abstract
Introduction: Advance care planning is a process that allows individuals to make decisions about their future healthcare, including end-of-life care, by discussing and documenting their preferences, values, and goals with healthcare providers and loved ones. These are especially critical for patients with serious, life-limiting conditions or for frail older adults who may face unexpected health crises. It is a commonly recognised barrier to care planning however that senior doctors often do not have the time to complete it for all patients who require them and that junior doctors lack confidence in having these discussions, this Quality Improvement Project aims at to increase the use of Advance care planning in the form of Emergency health care plan (EHCP) by empowering junior doctors to competently lead these discussions by introducing focussed teaching on the topic to regular teaching.
Method: Our objective was to organize teaching sessions for all junior doctors and LED doctors across University Hospitals of Leicester to educate doctors identifying suitable candidates and competently leading the discussion. So far we have delivered these sessions during Geriatric departmental teaching, IMT teaching and trust grade teaching and have gathered feedback to assess the teaching. We have also been collecting information on the total number of EHCPs completed by the trust over various periods, following the introduction of focused Advance Care Planning training into regular junior doctor teaching.
Result: After completing the original round of teaching, we found an overall improvement in the confidence that individuals had in both holding conversations about EHCPs and documenting the forms. 63.2% of participants now felt confident in conducting conversations, with 78.9% feeling confident to complete the EHCP form itself in the electronic system. As of now, we have not demonstrated an improvement in the number of EHCPs completed, with an initial result of 39 over the three months before teaching, compared to 36 after teaching. The 3rd cycle showed 33 EHCPs done after extending teaching programme. It was also noted that almost all EHCPs were completed in the context of advanced frailty and were not utilized for younger patients with terminal conditions.
Conclusion: This initiative has improved junior doctors’ confidence in leading ACP discussions, underscoring the value of targeted training in promoting patient-centered care. However, despite expanding the programme to include foundation doctors and GP trainees, there was no
increase in the number of completed EHCPs. Possible barriers include high doctor turnover, reduced staffing limiting time for discussions, and the complex nature of ACPs—often requiring multiple sessions or being deferred to the patient’s GP. An audit will be conducted during the next teaching cycle to explore these barriers and understand why increased confidence has not translated into improved completion rates.
Comments
Preparing medical students for advanced care planning.
An important study demonstrating how targeted teaching can improve junior doctors’ confidence in ACP discussions. From a medical student's perspective, it seems challenging to navigate these conversations without prior experience. I’m interested in your thoughts on how aspects of ACP training could be integrated into medical school curricula so that students have earlier exposure and preparation before entering clinical practice.
Yes, this certainly can be a…
Yes, this certainly can be a part of communication skills. As it is quite advanced communication, I usually let medical students observe how we conduct these discussions during ward placements. Early integration of Advance Care Planning (ACP) teaching in medical school could greatly enhance students’ confidence and competence. Embedding ACP within communication skills sessions using simulations, linking it to ethics teaching, and providing supervised clinical exposure would help normalize these conversations as part of routine care. Interprofessional workshops could further develop understanding of team-based approaches. Introducing these elements early and reinforcing them throughout training would better prepare future doctors for meaningful, patient-centered ACP discussions.
Numbers of patients identified
I found your project interesting and you may have found an increase in ACPs if your review period had not been when residents changed over.
One of the difficulties is the large number of patients where ACP conversations are helpful (as shown in your graph) and the limited time available.
Did you look at the characteristics of the patients who did have ACPs to see in what situations these were prioritised by the teams? eg was it higher CFS scores or specific diagnoses.
In our work to promote ACPs we have concentrated on highlighting those with CFS 8 or 9 as this feels a more manageable number whilst people are gaining confidence.
Did you have a look at how many people would have been identified by SPICT compared to those identified using the CFS?
We have a session on ACPs in the formal geriatric medicine teaching for medical students but including this in simulated communication skills training is a great idea.