{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:10:07Z","timestamp":1787008207347,"version":"build-2736575974"},"reference-count":39,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2021,7,16]],"date-time":"2021-07-16T00:00:00Z","timestamp":1626393600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Palliative Medicine"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Primary care clinicians care for most persons with Alzheimer's disease and related dementias (ADRDs), yet lack dementia-specific skills in advance care planning (ACP).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>To develop and evaluate a training toolkit for primary care clinicians to improve ACP communication for people with ADRD and their families.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Clinical practice outcomes assessment and pre\u2013post-training evaluation. Intervention training toolkit addressed ACP skills by dementia stage: (1) advance directives in early dementia, (2) decision-making capacity in moderate dementia, (3) Physician Orders for Life-Sustaining Treatment (POLST) in late-stage dementia, and (4) hospice and hospitalization in advanced dementia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting\/Subjects:<\/jats:title>\n                    <jats:p>Nonhospitalized clinical care sites, 51 clinicians in North Carolina, USA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements:<\/jats:title>\n                    <jats:p>Data collection utilized structured chart abstractions and pre- and post-training surveys.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Of 51 participants trained, 33 had encounters with patients with ADRD in study period. Most participants were women (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200942), white (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200937), and physicians (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200931). Participants increased documentation of surrogates (22.7% vs. 35.5%,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.03), decision-making capacity (13.5% vs.23.2%,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.04), and POLST completion (9.2% vs. 18.8%,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.03). Training increased ACP documentation (6.4% vs. 14.5%,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.031) and goals of care (GOC) decision-making discussions (17.0% vs. 31.9%,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.005). In pre\u2013post-comparisons, participant confidence increased in determining capacity, exploring dementia prognosis, GOC, eliciting surrogates, and leading family meetings (all\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Most participants strongly agreed that the training addressed skills used in practice (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200934), contained clear language (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200940), took an appropriate amount of time (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200932), and was designed effectively (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200935).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>This video-based training resource increased the use of dementia-specific ACP communication skills and clinician confidence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/jpm.2020.0638","type":"journal-article","created":{"date-parts":[[2021,1,5]],"date-time":"2021-01-05T15:32:36Z","timestamp":1609860756000},"page":"1183-1190","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":17,"title":["Evaluation of a Training Toolkit to Improve Clinicians' Skills for Dementia Advance Care Planning"],"prefix":"10.1177","volume":"24","author":[{"given":"Christine E.","family":"Kistler","sequence":"first","affiliation":[{"name":"Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA."},{"name":"The Cecil G. 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Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA."},{"name":"School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary S.","family":"Winzelberg","sequence":"additional","affiliation":[{"name":"Division of Geriatric Medicine and Palliative Care Program, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacey L.","family":"Gabriel","sequence":"additional","affiliation":[{"name":"The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher J.","family":"Wretman","sequence":"additional","affiliation":[{"name":"The Cecil G. 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