Can We Improve the Quality of Care at the End of Life in Israel?

This study will evaluate whether end-of-life simulation training of critical care physicians and nurses throughout Israel using standardized patients improves communication and interpersonal skills leading to improvements in ICU care process, teamwork and family satisfaction.

Design- Simulation training will include approximately 10-15 staff members from 4-5 ICUs during the first 12 months of the study (intervention group) who will be compared using a stepped wedge design to staff members from another 4-5 ICUs who will not receive initial simulation training (control group) in the first year but will receive training during the second year. To evaluate whether the simulation training with simulated standardized patients improves ICU professional's communication and interpersonal skills, a baseline evaluation before the training and an evaluation after the training will be required. Training using 9 essential skills for communication and interpersonal relationships that the study Steering Committee chose include: How to elicit patient preferences (including patient vs. family goals of care)? How does one listen? How to be more compassionate, show empathy and respect (including how to address emotions)? How to handle unrealistic patient/family expectations (including a family requesting "that everything be done")? How to handle prognostic uncertainty? How to handle decision making? How to handle conflicts between siblings or within the team? Physicians and nurses working together, and Becoming knowledgeable and understanding the Israeli Terminally Ill Law.

Simulation sessions- The simulation sessions include 6 scenarios. The simulation training is composed of several teaching sessions interspersed between clinical scenarios with simulated standardized patients (actors) performed with the ICU doctors and nurses and several subsequent debriefing sessions. The entire interchange between the trainee(s) and actor is video-taped for educational purposes and used in the subsequent debriefing.

Evaluations-

1. Baseline evaluation will consist of a questionnaire for self-evaluation, ICU process, teamwork and family satisfaction and performance testing using a simulation evaluation of the 9 skills before the teaching and training session. The trainee questionnaire will include demographic information including age, gender, country of birth, profession, education, years practicing, hospital type (private, governmental, health fund), number of ICU beds, religion, religiosity, previous experiences with death and the Israeli Terminally Ill Law. The simulation evaluation will access level of knowledge, skills and attitude. The baseline questionnaire will be administered on the morning of the simulation training or prior to that date if possible before the training begins. The questionnaires will be for the baseline and repeat questionnaires 3-6 and 12 months after the training in their units or by mail. The control group will receive their questionnaires (for the baseline questionnaire and the repeat questionnaire 3-6 and 12 months later) during the first year of the study (before the second year when their simulation training occurs) in their ICUs or by mail.