A Scalable Web-Based Module for Improving Surgical and Medical Practitioner Knowledge and Attitudes About Palliative and End-of-Life Care

Published in: Journal of Palliative Medicine, v. 18, no. 5, Apr. 2015, p. 415-420

Posted on RAND.org on July 16, 2015

by Jonathan Bergman, Karl Lorenz, Eric Ballon-Landa, Lorna Kwan, Steven E. Lerman, Christopher S. Saigal, Carol Bennett, Mark Litwin

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BACKGROUND: We built a web-based, interactive, self-directed learning module about end-of-life care. OBJECTIVE: The study objective was to develop an online module about end-of-life care targeted at surgeons, and to assess the effect of the module on attitudes towards and knowledge about end-of-life care. METHODS: Informed by a panel of experts in supportive care and educational assessment, we developed an instrument that required approximately 15 minutes to complete. The module targets surgeons, but is applicable to other practitioners as well. We recruited general surgeons, surgical subspecialists, and medical practitioners and subspecialists from UCLA and the GLA-VA (N=114). We compared pre- and post-intervention scores for attitude and knowledge, then used ANOVA to compare the pre- and postmodule means for each level of the covariate. We performed bivariable analyses to assess the association of subject characteristic and change in score over time. We ran separate analyses to assess baseline and change scores based on the covariates we had selected a priori. RESULTS: Subjects improved meaningfully in all five domains of attitude and in each of the six knowledge items. Individuals younger than 30 years of age had the greatest change in attitudes about addressing pain, addressing end-of-life goals, and being actively involved as death approached; they also had the most marked improvement in total knowledge score. Having a family member die of cancer within the last five years or a personal experience with palliative care or hospice were associated with higher change scores. CONCLUSIONS: A web-based education module improved surgical and medical provider attitudes and knowledge about end-of-life care.

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