Are family medicine residents adequately trained to deliver palliative care?

OBJECTIVE

To explore educational factors that influence family medicine residents' (FMRs') intentions to offer palliative care and palliative care home visits to patients.

DESIGN

Qualitative descriptive study.

SETTING

A Canadian, urban, specialized palliative care centre.

PARTICIPANTS

First-year (n = 9) and second-year (n = 6) FMRs.

METHODS

Semistructured interviews were conducted with FMRs following a 4-week palliative care rotation. Questions focused on participant experiences during the rotation and perceptions about their roles as family physicians in the delivery of palliative care and home visits. Participant responses were analyzed to summarize and interpret patterns related to their educational experience during their rotation.

MAIN FINDINGS

Four interrelated themes were identified that described this experience: foundational skill development owing to training in a specialized setting; additional need for education and support; unaddressed gaps in pragmatic skills; and uncertainty about family physicians' role in palliative care.

CONCLUSION

Residents described experiences that both supported and inadvertently discouraged them from considering future engagement in palliative care. Reassuringly, residents were also able to underscore opportunities for improvement in palliative care education.

Undergraduate palliative care teaching in Swiss medical faculties: a nationwide survey and improved learning objectives

BACKGROUND

In 2007, a first survey on undergraduate palliative care teaching in Switzerland has revealed major heterogeneity of palliative care content, allocation of hours and distribution throughout the 6 year curriculum in Swiss medical faculties. This second survey in 2012/13 has been initiated as part of the current Swiss national strategy in palliative care (2010 - 2015) to serve as a longitudinal monitoring instrument and as a basis for redefinition of palliative care learning objectives and curriculum planning in our country.

METHODS

As in 2007, a questionnaire was sent to the deans of all five medical faculties in Switzerland in 2012. It consisted of eight sections: basic background information, current content and hours in dedicated palliative care blocks, current palliative care content in other courses, topics related to palliative care presented in other courses, recent attempts at improving palliative care content, palliative care content in examinations, challenges, and overall summary. Content analysis was performed and the results matched with recommendations from the EAPC for undergraduate training in palliative medicine as well as with recommendations from overseas countries.

RESULTS

There is a considerable increase in palliative care content, academic teaching staff and hours in all medical faculties compared to 2007. No Swiss medical faculty reaches the range of 40 h dedicated specifically to palliative care as recommended by the EAPC. Topics, teaching methods, distribution throughout different years and compulsory attendance still differ widely. Based on these results, the official Swiss Catalogue of Learning Objectives (SCLO) was complemented with 12 new learning objectives for palliative and end of life care (2013), and a national basic script for palliative care was published (2015).

CONCLUSION

Performing periodic surveys of palliative care teaching at national medical faculties has proven to be a useful tool to adapt the national teaching framework and to improve the recognition of palliative medicine as an integral part of medical training.

Impact of a multifaceted education program on implementing a pediatric palliative care guideline: a pilot study

BACKGROUND

A national clinical practice guideline for pediatric palliative care was published in 2013. So far there are only few reports available on whether an educational program fosters compliance with such a guideline implementation. We aimed to test the effect of the education program on actual compliance as well as documentation of compliance to the guideline.

METHODS

We performed a prospective study with pre- and post-intervention evaluation on compliance to the guideline of the nurse specialists of a pediatric palliative care team for case management at a children's university hospital. Eleven quality indicators were selected from 192 recommendations from the pediatric palliative care guideline, based on frequency, measurability and relevance. The multifaceted education program included e-learning and an interactive educational meeting. Four e-learning modules addressed 19 patient cases on symptoms, diagnostics and treatment, and a chart-documentation exercise. During the interactive educational meeting patient cases were discussed on how to use the guideline. Documentation of compliance to the guideline in the web-based patient-charts as well as actual compliance to the guideline through weekly web-based parent reports was measured before and after completion of the e-learning.

RESULTS

Eleven quality indicators were selected. The educational program did not result in significant improvement in compliance for any of these indicators. The indicators "treatment of nausea", "pain medications two steps ahead" and "pain medication for 48 h present", measured through parent reports, scored a compliance beyond 80 % before and after e-learning. The remaining indicators measuring compliance, as well as six indicators measuring documentation by chart review, showed a compliance below 80 % before and after e-learning.

CONCLUSIONS

The multifaceted education program did not lead to improvement in documentation of compliance to the guideline. Parent reported outcome revealed better performance and might be the more adequate assessment tool for future studies.

Enhancing Communication Related to Symptom Management Through Plain Language

CONTEXT

Symptom management is a key dimension of palliative care. In addition to aspects such as assessment and pharmacological management of symptoms, professionals also require communication skills to effectively manage symptoms in serious illness.

OBJECTIVES

Application of the Plain Language Planner for Palliative Care(©), a provider tool for communicating about medication and symptoms using plain language, was tested.

METHODS

Approximately 75% of the 155 health care professionals, mostly nurses, who participated in a before-and-after educational activity about the tool, provided written communication explanations using one of three medication-symptom pairs: senna for constipation, amitriptyline for nerve pain, and lorazepam for anxiety. Responses were coded for plain language characteristics: active voice, second person, use of jargon, brief sentences, reading level, and easy to understand data phrasing. Frequency counts for coding categories were calculated and compared across medication-symptom pairs before and after the education session.

RESULTS

A comparison between written responses before and after the education session showed improvement in the use of plain language. Overall, plain language scores were highest for communication about senna (81%), followed by amitriptyline (72%) and lorazepam (77%). Across all three medication-symptom pairs, the greatest improvement in the use of plain language occurred in the use of jargon.

CONCLUSION

Provider training with the tool produced increased plain language. Use of the tool in provider education shows promise in increasing the health literacy for patients and families regarding symptom management.

"I wanted to communicate my feelings freely": a descriptive study of creative responses to enhance reflection in palliative medicine education

BACKGROUND

The recent growth of arts and humanities in medical education shows recognition that these disciplines can facilitate a breadth of thinking and result in personal and professional growth. However creative work can be a challenge to incorporate into a busy curriculum. Offering the option of creative media as a way of reflecting is an example of how this can occur. This study aimed to examine the medical student response to being given this option to explore a visit to a patient in a hospice.

METHODS

This was a mainly qualitative study. In the 2012 academic programme, the class of 86 students were given the option of using a creative medium to explore their responses to both the visit and their developing communication skills. Students were required to write an accompanying commentary if submitting the creative work option. Sixty-four percent of the class chose a creative medium e.g. poetry, visual art, narrative prose, music. These students were asked to take part in research including completing a short on-line survey and consenting for their creative work and commentaries to be further examined. The creative works were categorised by genre and the commentaries analysed using inductive thematic analysis.

RESULTS

Seventeen students completed the on-line survey and fifteen consented to their work being used for this research. Thematic analysis of the student commentaries revealed the following themes: effectiveness for expressing emotion or ideas that are difficult to articulate; engaging and energising quality of the task; time for reflection; flexibility for individual learning styles and therapeutic value.

CONCLUSIONS

Teaching the art of communicating at end-of-life is challenging especially when it involves patients, and teachers want to ensure students gain as much as possible from the experience. Offering the option to use creative media means that students can choose a medium for reflection that best suits them as individuals and that can enable them to benefit as much as possible from their experience.

Palliative Care Medical Education in European Universities: A Descriptive Study and Numerical Scoring System Proposal for Assessing Educational Development

CONTEXT

The lack of palliative medicine (PM) education has been identified as a barrier to the development of the discipline. A number of international institutions have called for its implementation within undergraduate medical curricula.

OBJECTIVES

The objectives are to describe the situation of undergraduate PM education in Europe and to propose a scoring system to evaluate its status.

METHODS

This descriptive study was conducted with data provided by key experts from countries of the World Health Organization European Region (n = 53). A numerical scoring system was developed through consensus techniques.

RESULTS

Forty-three countries (81%) provided the requested information. In 13 countries (30%), a PM course is taught in all medical schools, being compulsory in six of them (14%). In 15 countries (35%), PM is taught in at least one university. In 14 countries (33%), PM is not taught within medical curricula. A full professor of PM was identified in 40% of countries. Three indicators were developed to construct a scale (rank 0-100) of educational development: 1) proportion of medical schools that teach PM (weight = 32%); 2) proportion of medical schools that offer PM as a compulsory subject (weight = 40%); 3) total number of PM professors (weight = 28%). The highest level of PM educational development was found in Israel, Norway, the U.K., Belgium, France, Austria, Germany, and Ireland.

CONCLUSION

PM is taught in a substantial number of undergraduate medical programs at European universities, and a qualified teaching structure is emerging; however, there is a wide variation in the level of PM educational development between individual countries.

Undergraduate education in palliative medicine in Germany: a longitudinal perspective on curricular and infrastructural development

BACKGROUND

In 2009, palliative medicine became an integrated and compulsory part of undergraduate training in Germany by legislation. After a transitional period, all medical faculties were required to provide adequate teaching with an according examination and certification procedure. In parallel, we conducted bi-annual surveys on all medical faculties in Germany to examine for potential discrepancies between the implementation process and their intended consequences on teaching time and content.

METHODS

Four consecutive bi-annual surveys (2006, 2008, 2010, 2012) of all 36 medical faculties in Germany were performed, using purposively for this study developed questionnaires. Likert scales and closed questions were analyzed descriptively.

RESULTS

Medical Faculty response rate increased from 50 % in 2006 to 88.9 % in 2012. Teaching coordinators in palliative medicine primarily had an anesthesiology or internal medicine background. There was a noted increase over time of the involvement of specialized palliative care units (PCUs) as providing the setting for education. The number of faculties that were able to offer a complete 16 weeks of training in palliative medicine during the "final year" rose steadily. In addition, increased patient-centered teaching formats have been implemented over time. The faculties which offered innovative teaching formats with actors as patients (standardized patient interaction) increased, as did the total number of mandatory examinations. The number of faculties that provided compulsory teaching in a condensed manner within a single academic year increased sharply from 3 of 31 responding faculties in 2010 to 19 of 32 responding faculties in 2012.

CONCLUSIONS

Until now, teaching conditions and structures in palliative medicine in Germany have proven to be extraordinarily heterogeneous. Although professorships ("Chairs") in palliative medicine proved to be particularly beneficial and supportive in curricular and structural development, only a minority of faculties provide leading academic positions in palliative medicine.

Comparative analysis of specialization in palliative medicine processes within the World Health Organization European region

CONTEXT

Palliative medicine (PM), still in the development phase, is a new, growing specialty aimed at caring for both oncology and non-oncology patients. There is still confusion about the training offered in the various European PM certification programs.

OBJECTIVES

To provide a detailed, comparative update and analysis of the PM certification process in Europe, including the different training approaches and their main features.

METHODS

Experts from each country completed an online survey addressing historical background, program name, training requirements, length of time in training, characteristic and content, official certifying institution, effectiveness of accreditation, and 2013 workforce capacity. We prepared a comparative analysis of the data provided.

RESULTS

In 2014, 18 of 53 European countries had official programs on specialization in PM (POSPM): Czech Republic, Denmark, Finland, France, Georgia, Germany, Hungary, Ireland, Israel, Italy, Latvia, Malta, Norway, Poland, Portugal, Romania, Slovakia, and the U.K. Ten of these programs were begun in the last five years. The PM is recognized as a "specialty," "subspecialty," or "special area of competence," with no substantial differences between the last two designations. The certification contains the term "palliative medicine" in most countries. Clinical training varies, with one to two years being the most frequent duration. There is a clear trend toward establishing the POSPM as a mandatory condition for obtaining a clinical PM position in countries' respective health systems.

CONCLUSION

PM is growing as a specialization field in Europe. Processes leading to certification are generally long and require substantial clinical training. The POSPM education plans are heterogeneous. The European Association for Palliative Care should commit to establishing common learning standards, leading to additional European-based recognition of expertise in PM.

Perception of Palliative Care among Medical Students in a Teaching Hospital

INTRODUCTION

Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness. Palliative care must be a part of every medical personnel's practice. But still medical education curriculums have not included palliative care in its syllabus, sufficiently due to which most of the health professional are not aware about this specialty. The purpose of this study is to find out the perception of the medical students in palliative care in a teaching hospital.

METHODS

A descriptive study was done among 270 undergraduate medical students studying in Institute of Medicine using a self structured pretested questionnaire. Data was entered in Microsoft Excel and analyzed by using SPSS 21.

RESULTS

Of the total 270 undergraduate medical students only 152 has heard the word "palliative care". Only 84 students know, palliative care can be provided early in the life threatening illness. Total 80 students know it doesn't intend to postpone and hasten death. Though only 49 students didn't know PC is not included in our curriculum, 227 are interested to learn about it if given any opportunity.

CONCLUSIONS

The perception of palliative care medicine is low in first couple of year of medical study. It is increased in clinically exposed students but is surprisingly more in fourth year than final year undergraduate medical students. However, it should be included in undergraduate medical study.

Practicing End-of-Life Conversations: Physician Communication Training Program in Palliative Care

A Physician Communication Training Program (PCTP) utilizing scripts based on actual family conferences with patients, families, and the health care team was developed at one medical center in the Northeast. The program was designed, adapted, and directed by a palliative care social worker. The primary goal of the program is to help residents and attending physicians build better communication skills in establishing goals of care and in end-of-life planning. The scripts focus on improving physicians' basic skills in conducting family meetings, discussing advance directives, prognosis, brain death, and withdrawal of life support. Excerpts from the scripts utilized in the program are included. Feedback from participants has been positive, with all respondents indicating improvement in their capacity to take part in these challenging conversations.

Mentoring the Next Generation of Social Workers in Palliative and End-of-Life Care: The Zelda Foster Studies Program

As Americans live longer with chronic illnesses, there is a growing need for social workers with the knowledge and skills to deliver quality palliative care to older adults and their families. Nevertheless, there remains a critical shortage of social workers prepared to provide quality palliative and end-of-life care (PELC) and to maintain the field into the next generation. Formal mentorship programs represent an innovative approach to enhancing practice, providing support and guidance, and promoting social work leadership in the field. This article reviews the literature on mentorship as an approach to professional and leadership development for emerging social workers in PELC. The Zelda Foster Studies Program in Palliative and End-of-Life Care bolsters competencies and mentors social workers in PELC over the trajectory of their careers, and enhances the capacity in the field. Findings from the first six years of two components of the ZF Program are examined to illustrate the feasibility, benefits, and challenges of formal mentorship programs. The authors describe the background, structure, and evaluation of the initiative's mentorship programs, and discuss the implications of mentorship in PELC for social work education, practice, and research.

A qualitative exploratory study of nursing students' assessment of the contribution of palliative care learning

OBJECTIVE

We explored the contribution of optional palliative care (PC) learning to the training of undergraduate nursing students.

DESIGN

This is a qualitative, exploratory study.

PARTICIPANTS

PC students from two universities (n=236) responded to the open question: What was the contribution of the PC course to your training?

METHODS

A thematic analysis of the respondents' answers was performed with investigator triangulation.

FINDINGS

Four themes were identified. Firstly, the PC course provided a comprehensive view of the nursing discipline. Secondly, the course helped the students to know how to interact with, communicate with and better understand patients. Thirdly, the contribution of the course to the students' personal growth prompted them to reflect personally on death, thus promoting self-awareness. Finally, the students considered the PC course to be of great importance in the nursing curriculum.

CONCLUSION

Nursing students believed that a PC course was an essential component in their training, which contributed favourably to their personal and professional development.

Patients' nursing records revealing opportunities for interprofessional workplace learning in primary care: a chart review study

BACKGROUND

Working and learning go hand in hand during interprofessional collaborative practice. Patients' nursing records are designed to record patient care and health status. It is not known whether these records are also used to keep track of interprofessional contacts or interprofessional learning between team members. This study explored the usefulness of patients' nursing records in optimising interprofessional workplace learning for general practitioners.

METHODS

We utilized a descriptive retrospective chart review. All palliative home care teams of the Dutch speaking part of Belgium were involved. Throughout the year 2010, a representative sample of patient charts was selected. Characteristics of encounters between general practitioners and palliative care nurses were extracted from the charts.

RESULTS

Detailed accounts of interprofessional contacts were found in the charts. Palliative care nurses recorded number and type of contacts, topics discussed during contacts and general practitioner's learning activities.

DISCUSSION

Palliative care nurses are sensitive and open towards the general practitioners' learning needs. Patients' nursing records provide useful information for interprofessional team discussions on workplace learning. Healthcare professionals should be trained to respond to each other's learning needs.