Communicating with Families of Patients with Dementia: Enhancing Learners’ Skills through an Interdisciplinary Approach

Communicating with Families of Patients with Dementia: Enhancing Learners’ Skills through an Interdisciplinary Approach

Academic Year:
2013 - 2014 (June 1, 2013 through May 31, 2014)
Funding Requested:
Project Dates:
Overview of the Project:
In an effort to improve the care of patients with advanced dementia, we intend to create a new educational module for medical students and house staff. This training module will consist of a small group workshop using a trigger video illustrating the myriad of care needs and caregiver concerns that commonly arise in patients with advanced dementia. The module will focus on how best to communicate with and advise the families about care needs and nutritional concerns that arise in the late stages of dementia. We know from research that this area is one that many house staff that is training in Internal Medicine and Family Medicine feels unprepared. Specifically, eating and swallowing difficulties are common complications in advanced stages of dementia and are common sources of concern among families of patients with advanced dementia. It is paramount that medical students and house staff develop excellent communication skills and become comfortable discussing the expected course of advanced dementia with family members. Providers' unfamiliarity with the progressive course of dementia is cited as the most important barrier in providing optimal care to these patients. The video will be used both to elicit learners' knowledge of evidence-based approaches to eating problems and to provide evidence-based interdisciplinary expert opinion on the topic. Our intervention is innovative because we use an interactive small group seminar format to illustrate a true interdisciplinary approach to a problem that needs involvement of a team of healthcare providers to be successful.
Final Report Fields
Project Objectives:

1. To develop an interdisciplinary interactive educational intervention focused on teaching healthcare providers about caring for patients with end stage dementia, particularly focusing on eating and feeding problems in patients with end stage dementia. 2. To pilot test and implement a seminar focusing on eating and feeding problems in end stage dementia with healthcare trainees.

Project Achievements:

With CRLT funding we developed and piloted an interactive seminar utilizing a trigger video which we designed and filmed ourselves, depicting a family meeting addressing eating problems in a patient with AD. We also developed the accompanying materials for the seminar as well as survey instruments to assess its impact. We delivered this seminar to Internal Medicine and Neurology house-staff between Jan 2014 and Nov 2015. We also piloted it with a multidisciplinary group ( nurses, social workers) as part of a dementia care certificate via a live webinar. We used a retrospective pre/post survey to assess impact on trainees self reported confidence with skills. House-staff reported significantly improved confidence with ability to investigate eating problems and more confidence discussing eating problems with surrogate decisions makers. In addition they reported more confidence discussing burdens associated with feeding tube placement as well as alternatives to feeding tubes. Participants reported more confidence discussing ethical issues surrounding artificial nutrition. House-staff rated workshop as important, useful and educationally valuable. In conclusions Internal Medicine and Neurology housestaff reported significant improvement in confidence in their skills and rated the intervention highly. The intervention was also rated highly. Further testing on larger groups of house-staff and allied healthcare trainees is ongoing.

With support from the Department of Internal Medicine we made the seminar part of the curriculum for the Internal Medicine trainees and we are continuing to deliver the materials of our seminar with our allied healthcare trainees via a recorded seminar.
The seminar materials are available for use on the Portal for Online Geriatric Education (PogoE) and we presented our work at the Annual Assembly of Hospice and Palliative Medicine ( AAHPM) in Philadelphia in Feb 2015 in a session format as well as at the American Geriatric Society (AGS) in Long Beach in May 2016 as a poster presentation. Most recently we presented our poster at the Macy Midwest GME Conference in May 2016 in ann Arbor. We are in the process of publishing our implementation results on Med Ed Portal and in a medical education journal as well.
Advice to your Colleagues:
Funding from CRLT was instrumental in producing a high quality trigger video that is the center piece of our seminar.

The major challenge was finding the right spot for delivering the seminar in a busy learning environment. We used feedback from the participants in the pilot and were able to identify a group of trainees that benefitted from the seminar earlier on during their training period.