Measuring Program Impact: The ACE Project - Advocating for Clinical Excellence - Transdisciplinary Palliative Care Education

Background and Purpose: Excellence in palliative care requires skillful collaboration among professionals to address the multidimensional aspects of cancer care, yet evidence suggests that too few psycho-oncology professionals have been adequately trained to maximize their responsibility as advocates and change agents (Institute of Medicine, 2008). This presentation will describe the design and initial findings from a five-year, NCI-funded intensive leadership training program for 300 competitively selected psychologists, social workers and spiritual care professionals. The curriculum was developed consistent with the recommendations of the National Consensus Project for Quality Palliative Care: Clinical Practice Guidelines (2004; 2009) and the National Quality Forum (2006).

Methods: The investigative team developed an intensive three-day training program that encouraged exploration of role function, improved clinical judgment, professionalism, cultural sensitivity, accountability, and the development of improved inter-professional communication skills. Participants completed baseline evaluations and proposed institutional change goals. Process and outcome evaluation strategies were used to measure the effectiveness of the course and progress made by the participants toward meeting their identified goals. Application data and demographics were collected prior to each course. At the end of the training, participants rated the educational effectiveness of the program, as well as their confidence level regarding seven critical palliative care competencies. Extensive six-month follow-up evaluations examined the continued impact of the training and asked the participants to report again on their confidence regarding key palliative care competencies as well as on the progress that they have made instituting their change goals.

Results: This national training program had participants representing 45 of 50 states. The four courses received overwhelmingly positive ratings from the participants (Mean score of 4.77 on a scale of 1-5 with 5 being the highest evaluation possible). Participants rated their confidence in all seven palliative care competencies higher immediately following the course and importantly, their confidence was maintained six-months post-course. At six-months post-course, participants reported significant progress on meeting their goals. Thirty-two percent of the participants' goals were to provide increased palliative care education within their institutions. Twenty-nine percent of the participants' projects focused on direct strategies to improve clinical care, while 21% sought to provide organizational change.

Conclusions: The positive pre- and post-course evaluations and the six-month follow-up results of this innovative transdisciplinary training support the program's effectiveness in improving confidence of participants in seven critical palliative care competencies. The curriculum provided psycho-oncology professionals with strategies to become more effective change agents for enhanced palliative, end-of-life and bereavement care within their institutions.