CAN A COMPUTER-BASED DECISION AID TEACH MEDICAL STUDENTS ABOUT ADVANCE CARE PLANNING?

PURPOSE: To compare two strategies for teaching medical students how to engage patients in the process of advance care planning.

METHODS: A prospective, randomized, controlled trial of all second year medical students enrolled in a mandatory Ethics & Professionalism course at Penn State College of Medicine (n=133). Students were assigned to either Standard Group (using the Pennsylvania Living Will form), or Decision-Aid Group (using the investigators' computer-based decision aid, "Making your Wishes Known: Planning Your Medical Future") to facilitate an advance care planning discussion. Student knowledge, skill, confidence, and satisfaction were measured, as was patient perception of student performance.

RESULTS: Of the 133 eligible students, 89% (118) agreed to participate (60 Standard Group, 58 Decision-Aid Group). There were no group differences in age (mean 25 years), gender (50% female), or prior experience with advance care planning. Likewise, of the 118 patient-participants, there were no group differences in age (mean 57 years), gender (57% female), prior advance directive (20%), or computer ownership (92%).

1. Knowledge: Students' knowledge of advance care planning increased significantly in the Decision-Aid Group (84% pre-intervention → 88% post-intervention, p=0.0016), but not in the Standard Group (86% pre → 85% post, p=0.99). The change in knowledge was higher (p=0.0024) in the Decision-Aid Group (+5%) than in the Standard Group (-1%).
2. Skills: Students' confidence (1=not at all confident, 4=very confident) increased significantly (p<0.0001) in both groups, with the increase in confidence being higher (p=0.047) in the Decision-Aid Group than in the Standard Group (0.71 versus 0.5). Students' satisfaction with the advance care planning method (1=very dissatisfied, 5=very satisfied) was significantly greater (p<0.001) in the Decision-Aid Group (4.14) than in the Standard Group (3.35).
3. Performance: Patient satisfaction with student performance (1=not at all satisfied, 10=extremely satisfied) was significantly higher (p<0.001) in the Decision-Aid Group (9.68) than in the Standard Group (8.77), and patient satisfaction with the advance care planning method (1=very dissatisfied, 5=very satisfied) was significantly higher (p<0.001) in the Decision-Aid Group (4.19) than in the Standard Group (3.66).

CONCLUSIONS: As a method for teaching students how to discuss advance care planning with patients, our computer-based decision aid outperformed a standard living will form across all parameters measured.