Improving Clinician Confidence in Advanced Care Planning Using a Hybrid Teaching Model
Abstract
Introduction
Advanced Care Planning (ACP), including Proactive Elderly Advance Care (PEACE) planning, is an integral part of the holistic care we provide to our population, used to anticipate health needs and record individualised care preferences. The Electronic Palliative Care Co-ordinating System (EPaCCS) is a method of capturing these preferences and making them accessible to professionals in hospital and community settings. Referrals from hospital made up 1.28% of EPaCCS referrals in Mid Essex. A driver diagram identified opportunities for improvement, including the need for staff education; no formal ACP teaching existed for resident doctors, leaving many feeling ill-equipped entering sensitive PEACE plan discussions.
Methods
A hybrid lesson plan was designed with didactic teaching followed by debriefed role-play, where learners collaborated with simulated patients to generate a PEACE plan. In the first Plan Do Study Act (PDSA) cycle, ad-hoc sessions were delivered, and in the second, sessions were incorporated into the departmental teaching program. A survey assessed perceived confidence before and after sessions, alongside how useful and engaging learners found them. Simultaneously, referrals to EPaCCS and referral source were monitored.
Results
40 doctors received hybrid ACP teaching with 31 responding to the survey. The mean confidence improved from 2.61/5 to 4.52/5 with an average increase of +1.90. 100% of respondents found the session useful and 100% found the session engaging. Referrals to EPaCCS from hospital improved from 1.28% in October 2025 to 4.17% in January 2026 but this increase was not sustained.
Conclusions
While hybrid ACP teaching improved confidence in facilitating PEACE plans, this was not consistently reflected in the percentage of EPaCCS referrals from hospital. Obstacles included lack of access to IT referral systems and the rotational nature of placements. Therefore, future PDSA cycles will focus on software access and familiarisation, and training non-rotational members of the multidisciplinary team.