From: Implementing Advance Care Planning for dialysis patients: HIGHway project
Intervention | Activity |
---|---|
Implementation of each intervention | |
Resources | • Provide a resource-rich app that allows teams to easily access advance care planning and kidney supportive care tools • Through app: guide workflow for advance care planning and follow up |
Training | • Provide video conference training: ○ 6 h for social worker or nurse in role of advance care planning “coach” with patients (3 sessions of 2 h each over course of 6 weeks.) • Provide 6 h of social work CE for participation in training |
Ongoing supervision | • Provide monthly mentoring/supervision group on-line for social workers and nurses. Use a case-based approach to build skills in advance care planning |
Ongoing progress reports | • If site is using app for phone, iPad, or desktop, provide function on app to facilitate tracking and reporting completed conversations • In the alternative, social worker or nurse responds to short weekly email survey with 4 questions to capture ACP |
Quality check of ACP discussions | • Faculty review recording and provide feedback to social worker/nurse on recorded ACP sessions • Provide constructive criticism and coaching to improve discussions |
Evaluation after intervention | |
Patient Mail-in Survey | • Provide IRB approved survey link and/or hard copy for mailing to be handed to patients who participate in ACP discussions |
Social Worker/Nurse Online Survey | • Evaluation of training sessions includes both pre and post evaluation questions for comparison • Provide social worker survey (on-line) to evaluate participation in program, extent to which have adopted into ongoing workflow, identify facilitators and barriers, and assess future sustainability |