Skip to main content
SpringerLink
Log in

Teaching Advance Care Planning to Medical Students with a Computer-Based Decision Aid

  • Published:
Journal of Cancer Education Aims and scope Submit manuscript

Abstract

Discussing end-of-life decisions with cancer patients is a crucial skill for physicians. This article reports findings from a pilot study evaluating the effectiveness of a computer-based decision aid for teaching medical students about advance care planning. Second-year medical students at a single medical school were randomized to use a standard advance directive or a computer-based decision aid to help patients with advance care planning. Students' knowledge, skills, and satisfaction were measured by self-report; their performance was rated by patients. 121/133 (91%) of students participated. The Decision-Aid Group (n = 60) outperformed the Standard Group (n = 61) in terms of students´ knowledge (p < 0.01), confidence in helping patients with advance care planning (p < 0.01), knowledge of what matters to patients (p = 0.05), and satisfaction with their learning experience (p < 0.01). Likewise, patients in the Decision Aid Group were more satisfied with the advance care planning method (p < 0.01) and with several aspects of student performance. Use of a computer-based decision aid may be an effective way to teach medical students how to discuss advance care planning with cancer patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Doukas DJ, Brody H (1992) After the Cruzan case: the primary care physician and the use of advance directives. J Am Board Fam Pract 5:201–205

    CAS  PubMed  Google Scholar 

  2. Lo B, Steinbrook R (2004) Resuscitating advance directives. Arch Intern Med 164:1501–1506

    Article  PubMed  Google Scholar 

  3. Miles S, Koepp R, Weber E (1996) Advance end-of-life treatment planning. Arch Intern Med 156:1062–1068

    Article  CAS  PubMed  Google Scholar 

  4. Moskop JC (2004) Improving care at the end of life: how advance care planning can help. Palliat Support Care 2:191–197

    Article  PubMed  Google Scholar 

  5. Mullan PB, Weissman DE, Ambuel B, von Gunten C (2002) End-of-life care education in internal medicine residency programs: an interinstitutional study. J Palliat Med 5:487–496

    Article  PubMed  Google Scholar 

  6. Prendergast TJ (2001) Advance care planning: pitfalls, progress, promise. Crit Care Med 29:N34–N39

    Article  CAS  PubMed  Google Scholar 

  7. Schwartz CE, Merriman MP, Reed GW, Hammes BJ (2004) Measuring patient treatment preferences in end-of-life care research: applications for advance care planning interventions and response shift research. J Palliat Med 7:233–245

    Article  PubMed  Google Scholar 

  8. Tulsky JA (2005) Beyond advance directives: importance of communication skills at the end of life. JAMA 294:359–365

    Article  CAS  PubMed  Google Scholar 

  9. Emanuel LL, Emanuel EJ (1989) The Medical Directive. A new comprehensive advance care document. JAMA 261:3288–3293

    Article  CAS  PubMed  Google Scholar 

  10. McAuley WJ, Buchanan RJ, Travis SS, Wang S, Kim M (2006) Recent trends in advance directives at nursing home admission and one year after admission. Gerontologist 46:377–381

    PubMed  Google Scholar 

  11. Quill TE (2005) Terri Schiavo–a tragedy compounded. N Engl J Med 352:1630–1633

    Article  CAS  PubMed  Google Scholar 

  12. Barnard D, Quill T, Hafferty FW, Arnold R, Plumb J, Bulger R, Field M (1999) Preparing the ground: contributions of the preclinical years to medical education for care near the end of life. Working Group on the Pre-clinical Years of the National Consensus Conference on Medical Education for Care Near the End of Life. Acad Med 74:499–505

    Article  CAS  PubMed  Google Scholar 

  13. Schonwetter RS, Robinson BE (1994) Educational objectives for medical training in the care of the terminally ill. Acad Med 69:688–690

    Article  CAS  PubMed  Google Scholar 

  14. Sullivan AM, Lakoma MD, Billings JA, Peters AS, Block SD, Faculty PC (2005) Teaching and learning end-of-life care: evaluation of a faculty development program in palliative care. Acad Med 80:657–668

    Article  PubMed  Google Scholar 

  15. Sullivan AM, Lakoma MD, Block SD (2003) The status of medical education in end-of-life care: a national report. J Gen Intern Med 18:685–695

    Article  PubMed  Google Scholar 

  16. Block SD (2002) Medical education in end-of-life care: the status of reform. J Palliat Med 5:243–248

    Article  PubMed  Google Scholar 

  17. Buss MK, Marx ES, Sulmasy DP (1998) The preparedness of students to discuss end-of-life issues with patients. Acad Med 73:418–422

    Article  CAS  PubMed  Google Scholar 

  18. Green MJ, Levi BH (2009) Development of an interactive computer program for advance care planning. Health Expect 12:60–69

    Article  PubMed  Google Scholar 

  19. Jain NL, Kahn MG (1995) Using knowledge maintenance for preference assessment. Proc Annu Symp Comput Appl Med Care 1995:263–269

    Google Scholar 

  20. Torrance GW, Boyle MH, Horwood SP (1982) Application of multi-attribute utility theory to measure social preferences for health states. Oper Res 30:1043–1069

    Article  CAS  PubMed  Google Scholar 

  21. Torrance GW, Feeny DH, Furlong WJ, Barr RD, Zhang Y, Wang Q (1996) Multiattribute utility function for a comprehensive health status classification system. Health Utilities Index Mark 2. Med Care 34:702–722

    Article  CAS  PubMed  Google Scholar 

  22. Torrance GW, Furlong W, Feeny D, Boyle M (1995) Multi-attribute preference functions. Health Utilities Index. Pharmacoeconomics 7:503–520

    Article  CAS  PubMed  Google Scholar 

  23. Farace E, Marupudi N, Green MJ, Levi BH, Sheehan JM (2008) The Society for NeuroOncology 13th Annual Scientific Meeting, Las Vegas, NV

  24. Green MJ, Levi BH, Farace E (2007) Society for Medical Decision Making 29th Annual Meeting, Pittsburgh, PA

  25. Green MJ, Levi BH, Farace E (2008) American Society of Preventive Oncology Annual Meeting, Bethesda, MD

  26. Gallagher TH, Pantilat SZ, Lo B, Papadakis MA (1999) Teaching medical students to discuss advance directives: a standardized patient curriculum. Teach Learn Med 11:142–147

    Article  Google Scholar 

  27. Lorin S, Rho L, Wisnivesky JP, Nierman DM (2006) Improving medical student intensive care unit communication skills: A novel educational initiative using standardized family members. Crit Care Med 34:2386–2391

    Article  PubMed  Google Scholar 

  28. Levi BH, Green MJ (2010) Too Soon to Give Up: Re-examining the Value of Advance Directives. Am J Bioeth 10:3–22

    PubMed  Google Scholar 

  29. Pennsylvania Department of Aging (2010) Understanding Advance Directives for Health Care: Living Wills and Powers of Attorney in Pennsylvania. http://www.portal.state.pa.us/portal/server.pt?open=514&objID=616385&mode=2. Accessess 19 May

Download references

Acknowledgments

This research was supported by grants from the National Institutes of Health, National Institute of Nursing Research (1 R21 NR008539), Penn State University Social Science Research Institute, and Penn State University Woodward Endowment for Medical Science Education.

Author Disclosure Statement

The authors have intellectual property and copyright interests for the decision aid used for this study, and anticipate making the decision aid available through Penn State University as a marketed product (but with no-cost licensure for use with healthcare students).

Presented as a research abstract at the following professional meetings: Society for Medical Decision Making Annual Meeting, Philadelphia, PA., October 19, 2008; American Society of Bioethics and Humanities Annual Meeting, Cleveland, OH, October 23, 2008; and Society of General Internal Medicine Annual Meeting, Pittsburgh, PA, April, 2008.

Author information

Authors and Affiliations

  1. Departments of Humanities and Internal Medicine, Penn State College of Medicine, C1743, 500 University Drive, Hershey, PA, 17033, USA

    Michael J. Green

  2. Departments of Humanities and Pediatrics, Penn State College of Medicine, Hershey, PA, USA

    Benjamin H. Levi

Authors
  1. Michael J. Green
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Benjamin H. Levi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael J. Green.

Appendix 1: Advance care planning knowledge

Appendix 1: Advance care planning knowledge

figure afigure afigure a

Rights and permissions

Reprints and permissions

About this article

Cite this article

Green, M.J., Levi, B.H. Teaching Advance Care Planning to Medical Students with a Computer-Based Decision Aid. J Canc Educ 26, 82–91 (2011). https://doi.org/10.1007/s13187-010-0146-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13187-010-0146-2

Keywords

Search

Navigation