Equipping Resident Doctors with the Skills Required for Meaningful Advance Care Planning Conversations and Documentation

Introduction:

Advance care planning (ACP) is a vital aspect of geriatric medicine. Resident doctors often facilitate it through discussion and completion of ReSPECT forms. Quality of documentation can be variable, owing to limited experience, training, or confidence amongst residents¹. This can result in unclear escalation decisions and care that does not reflect patients' wishes.

Our project aimed to equip resident doctors with skills for ACP conversations and improve ReSPECT documentation.

Method:

We designed and delivered an ACP teaching session for resident doctors during their geriatrics rotation. We used case-based scenarios, exploring ACP, capacity, best-interests decisions, ceilings of care, and effective documentation.

Pre- and post-intervention data was collected by reviewing ReSPECT forms on three geriatric wards. Key measures included documentation of ceilings of care, capacity assessment, and communication with next of kin.

Results:

Following the intervention, all patients had a documented ReSPECT form (n=20), compared with 92% pre-intervention (n=50). Documented capacity assessment increased from 90% to 100%, and next-of-kin documentation increased from 24% to 90%.

Conclusions:

Our workshop provided a judgement-free environment for resident doctors to develop ACP communication and documentation skills. The session was concise and resource-efficient, making long-term delivery feasible.

This snapshot audit showed improvements in ReSPECT form completion, particularly next-of-kin documentation (24% to 90%). Pre- and post-intervention samples comprised different patients and differed in size (n=50 and n=20), thus findings should be interpreted as encouraging rather than definitive. The smaller gains, such as capacity assessment (90% to 100%), are within the expected variation for sample sizes. Feedback from the teaching sessions was positive (rated ‘useful’ or ‘extremely useful’), but for future sessions we will record pre- and post-session ‘doctor confidence’ to better evaluate their impact.

This project supports the principle that targeted teaching can improve resident doctors' engagement with ACP documentation. 

References:

1. Malhotra, C. and Chaudhry, I. (2023) ‘Barriers to advance care planning among patients with advanced serious illnesses’, Palliative and Supportive Care, 22(5), pp. 978–985. doi:10.1017/s1478951523000214.