352 Vol. 43 No. 2 February 2012Schedule With Abstracts

Who Is Attending? End-of-Life DecisionMaking in the ICU (318-C)Judith Baggs, PhD RN FAAN, Oregon Health &Science University, Portland, OR. MadelineSchmitt, PhD RN, University of Rochester, Ro-chester, NY. Thomas Prendergast, MD, PortlandVA Medical Center, Portland, OR. Sally Norton,PhD RN FPCN, University of Rochester, Roches-ter, NY. Craig Sellers, PhD RN ANP-BC GNP,University of Rochester, Rochester, NY. JillQuinn, PhD RN CS-ANP FNAP FAHA FAANP,University of Rochester, Rochester, NY.(All authors listed above for this session have dis-closed no relevant financial relationships withthe following exception: Baggs is an editor forWiley-Blackwell Publishers and receives anhonorarium.)

Objectives1. Discuss the contrast between the traditional

description of an attending physician in theICU and the reality in today’s ICUs.

2. Assess confusion in clinicians, family mem-bers, and patients, created by the way therole of the attending is actualized.

3. Discuss why ethnography was the appropriatemethod for this study.

Background. Traditional expectations of a singleattending physician who manages a patient’scare do not apply in today’s complex ICUs. Al-though many physicians and other professionalshave adapted to the rotation of multiple attend-ings, ICU patients and families often expect thetraditional, single physician model, particularlyat the time of end-of-life decision making(EOLDM).

Research objectives. Our purpose was to exam-ine the role of ICU attending physicians in mul-tiple ICUs and the consequences of that role forclinicians, patients, and families in the contextof EOLDM.

Method. Prospective ethnographic study in a uni-versity hospital, tertiary care center. We conduct-ed 7 months of observations (almost 3,000hours) and 157 semi-structured interviews of cli-nicians, patients, and family members in each of4 adult ICUs.

Result. The term attending physician was under-stood by most patients and family members tosignify an individual accountable person. Inpractice, "the attending physician" was a role,filled by multiple physicians on a rotating basisor by multiple physicians simultaneously.

Clinicians noted that management of EOLDMvaried in relation to these multiple and shiftingattending responsibilities.

Conclusion. The attending physician in thispractice context and in the EOLDM process cre-ated confusion for families and for some clini-cians about who was making patient-caredecisions and with whom they should confer.

Implications for research, policy, or practice.Any intervention to improve the process ofEOLDM in ICUs needs to reflect system changesthat address clinician and patient/family confu-sion about EOLDM roles of the various attend-ing physicians encountered in the ICU.

Improving Resident Skills In Code StatusDiscussions: A Randomized Controlled Trial(319-A)Rashmi Sharma, MD MHS, Northwestern Univer-sity, Chicago, IL. Elaine Cohen, BA, NorthwesternUniversity, Chicago, IL. William McGaghie North-western University Feinberg School of Medicine,Chicago, IL. Diane Wayne, MD, NorthwesternUniversity Feinberg School of Medicine, Chicago,IL. Eytan Szmuilowicz, MD, Northwestern Memo-rial Hospital, Chicago, IL.(All authors listed above for this session have dis-closed no relevant financial relationships.)

Objectives1. Describe the impact of an educational inter-

vention on resident code status discussionskills.

2. Identify specific clinical skills examinationitems in which trained residents performedbetter than control group residents.

3. Describe resident satisfaction levels with aneducational intervention on code status dis-cussion skills.

Background. Although internal medicine resi-dents frequently discuss code status with theirhospitalized patients, they often lack the confi-dence and skills to effectively carry out theseconversations.

Research objectives. We evaluated the effect ofan educational intervention on code status dis-cussion skills.

Method. PGY1 residents at an academic medicalcenter were randomized into two groups in July2010. The control group completed traditionalclinical training alone. The intervention groupcompleted traditional clinical training and

Vol. 43 No. 2 February 2012 353Schedule With Abstracts

received an educational intervention on codestatus discussions. The intervention included di-dactic instruction, role play, journal entries, andonline training modules. To assess the impact ofthe intervention, all control and interventiongroup PGY1 residents completed a code statusdiscussion clinical skills examination with a stan-dardized patient in Jan 2011. Two raters scoredeach videotaped discussion in the followingcategories: patient-centered interviewing skills,discussing code status, and responding to emo-tion. Scores were compared between the inter-vention and control group using t-tests.

Result. Fifty-six PGY1 residents were randomizedto the intervention (n ¼ 25) or control group(n ¼ 31). Intervention group residents had high-er total communication skills scores (74.4% �12.8% vs. 52.8% � 14.7% p < 0.001) than con-trol group residents. Trained residents also hadsignificantly higher scores than controls on indi-vidual items including: exploring patient under-standing of illness (100% vs. 58%), exploringpatient values/goals (84% vs. 45%), proposinga care plan that respects patient values/goals(60% vs. 10%), and exploring emotion (48%vs. 16%). Trained residents reported high satis-faction with the curriculum: 100% reportedthat training boosted their skills to performcode status discussions with real patients and92% said training helped prepare them forcode status discussions more than clinical expe-rience alone.

Conclusion. A multimodality educational inter-vention improves resident code status discussionskills.

Implications for research, policy, or practice.Further study is needed to demonstrate im-provement in actual clinical care and to assessskill retention.

Preventing the Lost-in-TranslationPhenomenon: Piloting a Curriculum forHealth Care Interpreters in End-of-LifeConversations (319-B)Anne Kinderman, MD, San Francisco GeneralHospital/University of California San Francisco,San Francisco, CA. Monique Parrish, DrPHMPH MSSW, LifeCourse Strategies, Orinda,CA. Cynthia Roat, MPH, Shoreline, WA.(All authors listed above for this session have dis-closed no relevant financial relationships.)

Objectives1. Describe the need for professionally-trained

interpreters in hospice and palliative care.2. Name two strategies to promote high-quality

communication with patients with limitedEnglish proficiency.

3. Identify current and future training opportu-nities for professional interpreters in pallia-tive and end-of-life care.

Background. Although studies suggest that us-ing professional healthcare interpreters im-proves care quality and satisfaction forpatients with limited English proficiency(LEP), significant communication errors maystill occur during crucial discussions betweenlanguage-discordant patients and providers.One potential explanation for the observedhigh rates of communication errors may bethat healthcare interpreters lack appropriatetraining in end-of-life discussions. Although in-terpreters have access to general training inhealthcare interpretation, there are no stan-dardized curricula or training programs forhealthcare interpreters in palliative care.

Case Description. We developed an innovativetraining program, Interpreting in PalliativeCare, to prepare healthcare interpreters forthe linguistic, cultural, and personal challengesof interpreting for palliative and end-of-life(EOL) discussions. A group of palliative carephysicians and interpreter trainers developedthe curriculum by reviewing relevant literatureand then performing a needs assessment of pal-liative care programs in California public hospi-tals, which serve a high percentage of LEPpatients (average 36%). The core elements ofthe eight-hour in-person/online training pro-gram include: (a) a conceptual introductionto palliative care; (b) three videos of EOL inter-preter-mediated encounters modeling bestpractices in palliative care interpreting; (c) anintroduction to palliative care vocabulary termsand exercises enabling practice interpretingfrom English to seven other languages, and (d)exercises on managing the emotional impact ofinterpreting for EOL conversations. The curricu-lum was pilot tested in a group of 15 experiencedinterpreters. Pre- and posttesting of participantsin the pilot group demonstrated that the curricu-lumwas effective in improving interpreter under-standing of palliative care and the specific