Abstract
Context
The 3-Act Model is an innovative narrative approach to goals of care (GOC) discussions
centered on patients' unique stories. Previous studies have demonstrated the effectiveness
of the 3-Act Model training in enhancing trainees' skills objectively in role-plays
with standardized patients. This study moves beyond the classroom to the clinical
setting to assess whether learners preferred this approach, believed it to be clinically
effective, and demonstrated proficiency objectively.
Objective
Our primary objective was to describe internal medicine interns' preferred approach
to leading GOC discussions and their view of its efficacy, before vs. after training.
Our secondary objective was to assess the proficiency of interns in leading GOC discussions
with hospitalized patients.
Methods
We sent online surveys to a cohort of 22 interns both before (pretest) and mid-year
after (posttest) training in the 3-Act Model. In addition, trainers objectively assessed
GOC discussions led by a subset of trainees in the inpatient setting using a previously
described rubric congruent with the 3-Act Model.
Results
In the posttest survey, many more interns reported using a narrative approach to GOC
discussions most often (pretest, 1 of 22 [5%] vs. posttest, 16 of 18 [89%]). The percentage
of interns reporting their preferred approach worked “very well” or “extremely well”
increased from pretest to posttest (32%–89%, P = 0.002). Trainers assessed 13 completed GOC discussions led by 4 trainees (18% of
original cohort) in the hospital setting and found all 13 to be proficient.
Conclusion
The vast majority of interns reported preferential use and effectiveness of the 3-Act
Model several months after training, and trainers found a subset to be proficient
in GOC discussions with hospitalized patients. This study contributes evidence that
training in the 3-Act Model positively impacted intern behavior in the clinical setting.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Pain and Symptom ManagementAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Achieving goal-concordant care: a conceptual model and approach to measuring serious illness communication and its impact.J Palliat Med. 2018; 21: S17-S27
- Barriers to goals of care discussions with seriously ill hospitalized patients and their families: a multicenter survey of clinicians.JAMA Intern Med. 2015; 175: 549-556
- “I just felt like I was stuck in the middle”: physician assistants' experiences communicating with terminally ill patients and their families in the acute care setting.J Pain Symptom Manag. 2017; 54: 27-34
- Feasibility and effectiveness of a mnemonic approach to teach residents how to assess goals of care.J Palliat Med. 2019; 22: 696-701
- Narrative approach to goals of care discussions: a novel curriculum.J Pain Symptom Manag. 2019; 58: 1033-1039
- The effect of communication skills training for generalist palliative care providers on patient-reported outcomes and clinician behaviors: a systematic review and meta-analysis.J Pain Symptom Manag. 2017; 54: 404-416
- A new path of the waterfall: poems.Atlantic Monthly Press, New York1989
- Critical care: a new nurse faces death, life, and everything in between.HarperCollins, New York2010: 113-128
- Curriculum development for medical education: a six-step approach.Johns Hopkins University Press, Baltimore2016: 134
- Assessment of an interprofessional online curriculum for palliative care communication training.J Palliat Med. 2014; 17: 400-406
- COMFORT™ SM communication for oncology nurses: program overview and preliminary evaluation of a nationwide train-the-trainer course.Patient Educ Couns. 2018; 101: 467-474
- Atomic habits: tiny changes, remarkable results: an easy and proven way to build good habits and break bad ones.Penguin Random House, New York2018: 141-147
- Principles: life and work.Simon & Shuster, New York2019: 356-370
Article info
Publication history
Published online: June 26, 2020
Accepted:
June 8,
2020
Series Editor: Amy A. Case, MD, FAAHPMIdentification
Copyright
© 2020 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
