Use of a simulated group visit to introduce advance care planning in the primary care setting
Bibliographic record
Abstract
Background and objective: When serious illness prevails or when faced with an end-of-life event, nurses should recognize symptoms and support patients with decision-making. By encouraging advance care planning (ACP) in the outpatient setting, patient involvement is enhanced. Objective: A performance improvement plan was used to increase nurse care manager confidence levels with hosting ACP conversations.Methods: Design: Care managers attended a two-hour simulated session to observe how to educate and prepare patients to complete advance directives. The session included a video introduction with two different group activities that encouraged sharing experiences from the peer perspective. Options for care were explored, focusing on selecting a health care power of attorney and promoting an end-of-life values conversation. Setting/Participants: The group visit occurs in the outpatient setting in a small group with five nurse care managers in the first visit and nine nurses in the second visit. Measures: Using a Likert scale, a pre/post-visit survey was given with eight questions to measure confidence levels with ACP in the group visit setting. Follow-up interviews were voluntarily conducted to measure confidence in completing an ACP conversation with a friend or family member.Results: Eight of the fourteen care managers participated in the post-visit interviews. 63% expressed themes of increased comfort in understanding and sharing ACP steps. The overall mean for pre/post survey confidence level increased from 3.77 to 4.33 (S.D. 0.25), with the most significant increase centered around confidence to lead a values conversation to select preferences for care.Conclusions: This performance improvement plan to promote ACP in the outpatient setting aligns with past studies promoting a group visit to educate and prepare patients to complete advance directives. Although findings may have limited generalizability, due to their small sample size, future group visits should be considered as a possible solution to meet busy time constraints in the primary care office.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.007 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.011 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".