70 Goals of care training for residential aged care staff: findings from IMPART trial

<h3>Aim</h3> To investigate Goals of Care (GoC) training needs from the aged care staff perspective. <h3>Background</h3> RACF GoC are shared decision-making medical treatment plans, combining the current medical context with advance care planning (ACP) or communicated wishes. GoC can improve end-of-life care (EOLC) by ensuring medical management aligns with the preferences and values of the older person, within applicable medical limitations. The IMPART intervention is an interactive, co-designed needs-based program for aged care staff that includes GoC training. <h3>Methods</h3> NHMRC-funded, 2.5-year pragmatic stepped-wedge cluster randomised trial (ACTRN12622000760774) commenced in May 2023. Staff and visiting GPs from 10 Melbourne RACFs joined a Planning Ahead Team to develop and implement a plan to improve EOLC. Teams: (i) conducted a needs analysis involving audits of 5–10 current and recently deceased resident files to identify gaps in EOLC; (ii) completed anonymous surveys about their confidence in providing EOLC; and (iii) engaged in an interactive workshop to co-design their action plan, including goals to be achieved over the 6-month intervention. <h3>Results</h3> Six RACFs have completed the intervention. Results showed that at three of the six facilities, ’end-of-life documents include wishes expressed by the resident and family’. At the six facilities, it was reported that ‘Completed EOL planning documents provided sufficient detail to support decision making and guide EOLC’ – ‘sometimes’. Analysis of six action plans revealed eight goals on the theme ’Documentation of GoC and resident care preferences.’ All six RACFs identified GoC training as a strategy for addressing this needs gap, and 29 staff (including 1 GP) participated in GoC training, tailored to each RACF’s expressed needs. <h3>Discussion</h3> Aged care staff identified the need for GoC training; a core component of the IMPART intervention. Supporting aged care staff to identify EOLC training needs can help target training efforts and achieve high staff engagement. <h3>Unique Contribution</h3> Findings highlight tailored GoC training as a critical component of programs designed to improve EOLC in RACFs. <h3>Implications</h3> This study has implications for high-quality, person-centred care, aligning with a resident’s goals and preferences for EOLC. It provides evidence for GoC training for all aged care staff, emphasizing tailored programs that address specific facility needs. Policy implications include collaborating with staff to undertake needs analysis to develop GoC training that is wanted and valued by staff, funding its development, and incorporating it into accreditation standards.