Jacqueline K Yuen1, Amy S Kelley2, Laura P Gelfman2, Elizabeth E Lindenberger2, Cardinale B Smith3, Robert M Arnold4, Brook Calton5, Jane Schell6, Stephen H Berns7. 1. Department of Medicine, The University of Hong Kong, Hong Kong SAR, China. Electronic address: jkyuen@hku.hk. 2. Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Geriatric Research Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA. 3. Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA. 4. Division of General Internal Medicine, University of Pittsburgh, Pittsburg, Pennsylvania, USA. 5. Division of Palliative Medicine, University of California, San Francisco, California, USA. 6. Division of Renal-Electrolyte, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. 7. Division of Palliative Medicine, University of Vermont, Burlington, Vermont, USA.
Abstract
CONTEXT: High-quality advance care planning (ACP) discussions are important to ensure patient receipt of goal-concordant care; however, there is no existing tool for assessing ACP communication quality. OBJECTIVES: The objective of this study was to develop and validate a novel instrument that can be used to assess ACP communication skills of clinicians and trainees. METHODS: We developed a 20-item ACP Communication Assessment Tool (ACP-CAT) plus two summative items. Randomized rater pairs assessed residents' performances in video-recorded standardized patient encounters before and after an ACP training program using the ACP-CAT. We tested the tool for its 1) discriminating ability, 2) interrater reliability, 3) concurrent validity, 4) feasibility, and 5) raters' satisfaction. RESULTS: Fifty-eight pre/post-training video recordings from 29 first-year internal medicine residents at Mount Sinai Hospital were evaluated. ACP-CAT reliably discriminated performance before and after training (median score 6 vs. 11, P < 0.001). For both pre/post-training encounters, interrater reliability was high for ACP-CAT total scores (intraclass correlation coefficient or ICC = 0.83 and 0.82) and the summative items Overall impression of ACP communication skills (ICC = 0.73 and 0.80) and Overall ability to respond to emotion (ICC = 0.83 and 0.82). Concurrent validity was shown by the strong correlation between ACP-CAT total score and both summative items. Raters spent an average of 4.8 minutes to complete the ACP-CAT, found it feasible, and were satisfied with its use. CONCLUSION: ACP-CAT provides a validated measure of ACP communication quality for assessing video-recorded encounters and can be further studied for its applicability with clinicians in different clinical contexts.
CONTEXT: High-quality advance care planning (ACP) discussions are important to ensure patient receipt of goal-concordant care; however, there is no existing tool for assessing ACP communication quality. OBJECTIVES: The objective of this study was to develop and validate a novel instrument that can be used to assess ACP communication skills of clinicians and trainees. METHODS: We developed a 20-item ACP Communication Assessment Tool (ACP-CAT) plus two summative items. Randomized rater pairs assessed residents' performances in video-recorded standardized patient encounters before and after an ACP training program using the ACP-CAT. We tested the tool for its 1) discriminating ability, 2) interrater reliability, 3) concurrent validity, 4) feasibility, and 5) raters' satisfaction. RESULTS: Fifty-eight pre/post-training video recordings from 29 first-year internal medicine residents at Mount Sinai Hospital were evaluated. ACP-CAT reliably discriminated performance before and after training (median score 6 vs. 11, P < 0.001). For both pre/post-training encounters, interrater reliability was high for ACP-CAT total scores (intraclass correlation coefficient or ICC = 0.83 and 0.82) and the summative items Overall impression of ACP communication skills (ICC = 0.73 and 0.80) and Overall ability to respond to emotion (ICC = 0.83 and 0.82). Concurrent validity was shown by the strong correlation between ACP-CAT total score and both summative items. Raters spent an average of 4.8 minutes to complete the ACP-CAT, found it feasible, and were satisfied with its use. CONCLUSION:ACP-CAT provides a validated measure of ACP communication quality for assessing video-recorded encounters and can be further studied for its applicability with clinicians in different clinical contexts.
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