The objective is to assess neurology resident attitudes surrounding Advanced Care Planning (ACP) and determine if educational sessions increased the number of Physician Orders for Life Sustaining Treatment (POLSTs).

Studies show that providers express discomfort surrounding ACP and interest in didactics on this topic. This project was undertaken as part of a larger quality improvement initiative to improve knowledge around ACP in neurology.

A one-hour interactive ACP education session was hosted by a Palliative Care physician in November 2023. The session focused on POLSTs as they are accessible to providers and patients. Anonymous surveys to determine attitudes surrounding ACP were collected pre- and post-session. Chart review was done to track POLSTs signed during hospitalizations five months before and after the education session (June 2023-April 2024) for patients discharged from the stroke service. 

Out of 22 session attendees, 13 responses were collected (59.09%). At baseline, attendees appeared to value ACP with 69.23% reporting it was “extremely important” to initiate ACP discussions. However, only 15.39% of attendees were “extremely likely” to initiate these discussions and 23.08% of attendees had never filled out a POLST. Attendees identified lack of knowledge and time as barriers to ACP discussions. After the education session, 84.62% of attendees were “extremely likely” to initiate ACP discussions, 46.15% were “extremely comfortable” identifying POLST candidates (0% prior to session) and 76.92% felt “extremely comfortable” filling out a POLST (7.7% prior to session). However, in the five months after the session, there was no increase in the uploaded POLSTs for discharged stroke patients.

Despite positive feedback to an ACP education session, there was no change in uploaded POLSTs post-session. This emphasizes a need for systematic, multidisciplinary approaches to increase frequency of ACP discussions and subsequent POLST completions for patients with neurological disease.