Tanya Griesenbeck, BSN, RN EDHP 500: Teaching and Learning Theory August 7, 2013

Topic: Identifying Hospice Eligible Candidates

Audience: Actively Practicing Medical Doctors

Learning Objectives: 1. By the end of the course, the physician will recognize personal biases and beliefs about end of life. 2. By the end of the course, the physician will identify misconceptions about hospice services 3. By the end of the course, the physician will identify barriers affecting physician-initiated end of life conversation. 4. By the end of the course, the physician will appropriately use standardize tools to help determine hospice eligible patients. 5. By the end of the course, the physician will summarize benefits offered by hospice.

Learning Theory I will use the cognitive learning theory approach, which is an aspect of the adult learning theory, to educate practicing physicians on appropriate hospice referrals. As adult learners, physicians will be motivated by using prior knowledge and experiences to build schemata. In the cognitive learning theory, adding knowledge and strategies will allow for changes in behavior. (Mayer, 2010) Adult learners must be participating in meaningful activities to help with retention, as learners do not have the processing capacity to retain all available information. The methods of delivery include but not limited to didactic (using visuals like power point), self-reflection, and case study exercises. Physicians will identify a personal experience by reflecting on a patient visit with a terminal or chronic illness. The physicians will participate in a self-guided exercise that requires swapping roles with that patient and reflecting on their own personal views as the patient. Doctors must recognize personal biases, beliefs, and misconceptions regarding hospice. The lack of communication about hospice with terminally ill patients and families must be identified. (Rhodes, Teno, & Welch, 2006) One study suggests hospice availability may not be distributed between all racial and ethnic backgrounds. It is imperative that patients be educated with options and involved in their own health care decisions. Physicians will participate in case studies and power point presentations to help learn about hospice. Repetition of data occurs but also cues in on the main objectives of the course. These strategies will help build schemata and make connections with prior knowledge. With the constructivist learn theory, the use of meaningful activities, dual coding, organizing information, and elaborative examples are crucial to a positive learning environment.

Assessment of Outcomes At the beginning of the course, prior to any discussions, a short questionnaire will be filled out by each participating physician. This initial assessment will allow the educators to better tailor educational needs and help identify previous knowledge and beliefs about hospice. Physicians will use multiple standardize assessment tools to scoring several case study patients. These measureable tools will help physicians better understand importance of standardized measurements in determining hospice eligible patients. The formal training received will allow for more accurate scoring and consistency. (Patel, Yoskowitz, & Arocha, 2009) Informal learning occurs daily but formal education and training allows for competent and proficient practitioners. Most physicians get on-the-job training with these assessment tools. The physicians will do self-assessments and will receive feedback for help with comprehension. Formative assessments with specific feedback and self-evaluations assessments are useful ways of performing evaluations in the cognitive learning theory. By understanding the full range of hospice benefits, identifying personal biases and beliefs, and identifying barriers to communication, the hopes is that physicians will focused on patient centered outcomes. Self-refection will be ongoing throughout the course to allow for continual self-improvements and awareness. (Weckmann, 2008) Family physicians, because of established relationships, can promote communication and continuity of care to patients and their families when end of life issues need to be addressed. The course completion questionnaire will be the same as the initial questionnaire. There will also be a self reporting questionnaire sent out 6 months after course completion to self evaluate on hospice referrals and retention from the course.

References Mayer, R. (2010). Applying the science of learning to medical education. Medical Education, 44(6), 543-549. doi:10.1111/j.1365-2923.2010.03624 Rhodes, R., Teno, J., & Welch, L. (2006). Access to hospice for African Americans: are they informed about the option of hospice?. Journal Of Palliative Medicine, 9(2), 268-272. Patel, V., Yoskowitz, N., & Arocha, J. (2009). Towards effective evaluation and reform in medical education: a cognitive and learning sciences perspective. Advances In Health Sciences Education: Theory And Practice, 14(5), 791-812. doi:10.1007/s10459-0079091-1 Weckmann, M. (2008). The role of the family physician in the referral and management of hospice patients. American Family Physician, 77(6), 807-812.

HOSPICE SELF-ASSESSMENT QUESTIONNAIRE

Name__________________________ Date__________________________

1. What is the purpose of hospice?

_________________________________________________________________________________________________________ _________________________________________________________________________________________________________

2. Name hospice services/benefits available to patients and families?

_________________________________________________________________________________________________________ _________________________________________________________________________________________________________

3. Name common terminal diagnoses used with hospice patients?

______________________ ______________________ _______________________ _______________________ ______________________ ______________________ ________________________ ________________________

4. How long is the initial Medicare benefit period? _________ Days 5. Second benefit period? __________ Days 6. Third benefit period? __________Days 7. Are transfusions allowed while on hospice? Yes Maybe No 8. Is chemotherapy allowed while on hospice? Yes Maybe No 9. What percentage of people do you think wants to die at home? ______ 10. What percentage of those people do you think actually die at home? _________% 11. Do you feel comfortable referring clients to hospice? Yes No 12.If No, Why Not? __________________________________________________________________________ 13.Estimate what percentages of your current clients have advanced directives/DNR status? 14. When a crisis arises, what does your office staff usually do? 15. Do you sometimes feel uncomfortable about bringing up hospice with terminally ill patients and their families? Yes No 16. Do you, as a physician, benefit from hospice staff seeing your patients? Yes- How: __________________________________________________________________________________ No Why Not: ____________________________________________________________________________ 17.Name 3 specific measuring tools used to help determine hospice eligible patients? ___________________ ________________ __________________
Discuss clients options Recommend sending to the ER 0-24% 25-50% 51-75% > 75%

Handout Connection As physicians are adult learners, they need to be aware of their own beliefs and current practices. This handout requires some self-refection and self-assessment, which are part of cognitive learning theory. Educators need to have an idea of the current knowledge level of the learner to best educate to the learners needs. This handout will help address the objectives in this course as well as give relevant feedback to both educator and student. This handout will be used at both the beginning and end of the course. By giving this questionnaire twice, educators are able to see if important facts and data have been retained. With the cognitive learning theory, learners take etched prior knowledge; combine it with new knowledge, to create a change in behavior. The goal of this handout is to create a selfawareness practice questionnaire that will increase client-centered involvement, outcomes, and awareness of hospice eligibility.