1. Assessing the Unmet Needs of Health Care Providers Using a Web-Based Survey Ruth McCorkle, PhD, FAAN Connecticut Coalition to Improve End-of-Life Care Connecticut Department of Public Health Connecticut Cancer Partnership

2. Purpose To develop and administer a web-based survey to identify the educational needs of health care professionals who provide end- of-life care in the State of Connecticut

3. Phase 1 Activities Literature search of existing survey tools Key content areas: Knowledge and technical skills Communication and interpersonal skills Spiritual and cultural issues Ethical, professional and legal principles. Organizational skills (system navigation, time management). Attitudes, values, and feelings

4. Phase 1 Activities A 56 item survey constructed Items were rated on a 5-point Likert scale (1=Strongly Disagree; 5= Strongly Agree) Additional Information: education, work history, and demographics Transfer of survey to a web-based medium/pilot testing Administration of the web-based survey to a state-wide sample

5. Phase 1 Activities Sample: nurses, nurses’ aides, physicians, social workers, pharmacists, chaplains, funeral directors, and administrators who were over 21 years of age and spoke English and worked in EOL care Participants were recruited by the Internet, at professional meetings and by direct contact

6. Phase 2 Activities Focus groups to elicit in-depth information about unmet education needs Data analyses Publication and dissemination of results

7. Results Six hundred and fifty-nine surveys were completed, 319 on the web and 340 on paper Six hundred and two had complete data

8. N=69 N=42 N=253 N=142 N=26 N=4 N=22 N=34 State of Connecticut Counties

9. Table 1: Surveys Completed by Group Professional Group Completed Survey (n=659) Final Sample (n=602) n % Nurse 288 43.7 261 43.3 Nurses’ Aide 173 26.3 168 27.9 Physician 97 14.7 93 15.4 Pharmacist 30 4.6 27 4.5 Chaplain 25 3.8 25 4.2 Administrator 22 3.3 6 1.5 Social Worker 15 2.3 15 2.5 Funeral Director 5 0.7 4 0.7

10. Top Five EOL Education Needs by Percent of Total Sample (n=602)

11. Sample (n=602) PercentN White81489 Female88529 Catholic51304 Master’s Degree36238 Advanced Directive35202 Attend National EOL Program 20122 Mean Age45602 Yrs of Practice16602

12. Knowledge about Ethics Higher Score = Greater Knowledge

13. Knowledge about Symptom Management Higher Score = Greater Knowledge

14. Knowledge about Communicating with Patients & Families Higher Score = Greater Knowledge

15. Knowledge about Care of the Body after Death Higher Score = Greater Knowledge

16. Knowledge about Care of patient at time of death Higher Score = Greater Knowledge

17. Knowledge about Needs of Family Caregivers Higher Score = Greater Knowledge

18. Knowledge about Grief/Bereavement Higher Score = Greater Knowledge

19. Phase 2-Activities Three focus groups composed of 30 total participants Focus groups confirmed survey results and highlighted the need for processing of EOL issues to enhance personal and professional knowledge and comfort

20. Conclusions The survey identified gaps in end- of-life education by total sample and by disciplines

21. Recommendations Education for all disciplines in key areas of end-of- life care, with attention to discipline-specific needs Priority on knowledge and skills related to cultural factors influencing EOL care Priority on dealing with patients’ and families’ religious and cultural beliefs

22. Recommendations Priority on helping work environments to provide resources to support staff who provide EOL care Education to understand and discuss goals of palliative care Education on importance of Advanced Directives Shorter educational sessions, possibly spread over 1-2 days, on-site training