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advance care planning, communication, end-of-life care planning, nursing simulation, palliative care



  1. Ellis, Brandy DNP, APRN, FNP-C
  2. Winn, Sheryl DNP, APRN, ANP-BC
  3. MacMillan, Deborah PhD, RNC, CNM
  4. Bouthillet, Kelly DNP, APRN, CCNS, ACNP-BC, FNP-C
  5. Purcell, Cynthia DNP, APRN, CNS, CNE


The Centers for Disease Control and Prevention reports that one-third of all Americans have not done any advance care planning, which is essential for maintaining autonomy when people are no longer able to communicate wishes directly at the end of life. The Institute of Medicine reports that providers have limited training in communication techniques and low confidence in holding advance care planning conversations. Forty-four family nurse practitioner students received classroom communication training using evidence-based end-of-life nursing education consortium materials and role-play opportunities. One month later, students participated in a palliative care simulation experience in a high-fidelity simulated medical office environment with standardized patient. The family practice nurse practitioner students were required to communicate bad news of a poor diagnosis to a family member and begin the advance care planning conversation using the SPIKES protocol. Findings include a significant increase in postintervention advance care planning communication knowledge scores and self-confidence in holding these conversations (mean, 30.55 [SD, 2.992]; 95% confidence interval, 29.64-31.46; median, 31; range, 11-35) and satisfaction with the learning experience (mean, 18.14 [SD, 2.11]; 95% confidence interval, 17.50-18.78; median, 19; with range between 13 and 20).