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Kidney Week

Abstract: SA-PO017

Evaluation of an Online Conservative Care Curriculum for Nephrology Fellows

Session Information

  • Educational Research
    November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Educational Research

  • 800 Educational Research

Authors

  • Schell, Jane O., University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
  • Bursic, Alexandra E., University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
  • Chan, Emily, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
  • Cohen, Robert A., Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
Background

Older patients with advanced kidney disease experience increased mortality and morbidity despite life prolonging treatments such as dialysis. Conservative care (CC) without dialysis may provide better symptom management and quality of life. Yet nephrologists rarely offer CC, and most patients initiate dialysis without knowing about CC as a treatment option. We developed an online CC curriculum for nephrology fellows to increase knowledge and preparedness in CC skills.

Methods

ACGME accredited nephrology programs were invited to participate in the curriculum and designate a nephrology educator to serve as local champion of the curriculum. Participating programs received the multimodal curriculum including: 1) four online content modules; 2) online communication skills demonstrations; 3) worksheet activities; and 4) a post-curriculum session at each participating program facilitated by local champion to augment the online learning. Using RedCap data management, pre- and post- surveys measured fellow experience, preparedness, and knowledge in CC before and after undergoing the curriculum.

Results

Nineteen nephrology programs participated in the online CC curriculum. 150 of 176 participating fellows (85%) completed the CC pre-survey. Fifty-nine (49%) of fellows were female and almost all were first or second year fellows. Over 75% reported no or limited (1-2 times) teaching in how to define CC, identify who would benefit from CC, and use a values-based communication framework for treatment decisions for CC or time-limited trial (TLT). Using a 5-point Likert scale, most fellows felt ‘not very’ or ‘somewhat’ prepared to use a communication framework for treatment decisions for CC or TLT. Almost all fellows who completed the curriculum (46 at time of submission) felt ‘very’ and ‘extremely’ prepared to do the following: define conservative care; identify patients who will do poorly on dialysis; how to respond when a patient is emotional; and how to incorporate values-based communication framework for CC and TLT. Almost all fellows were ‘very’ to ‘extremely’ satisfied with the curriculum.

Conclusion

Fellows report little to no preparedness in CC or how to discuss CC with patients. An online conservative care curriculum led to increased perceived preparedness in core CC skills. Future research can track CC curriculum impact on patient outcomes and treatment decisions.