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Stakeholders' views on identifying patients in primary care at risk of dying: a qualitative descriptive study using focus groups and interviews. Br J Gen Pract 2018; 68:e612-e620. [PMID: 30104331 DOI: 10.3399/bjgp18x698345] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 04/30/2018] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Strategies have been developed for use in primary care to identify patients at risk of declining health and dying, yet little is known about the perceptions of doing so or the broader implications and impacts. AIM To explore the acceptability and implications of using a primary care-based electronic medical record algorithm to help providers identify patients in their practice at risk of declining health and dying. DESIGN AND SETTING Qualitative descriptive study in Ontario and Nova Scotia, Canada. METHOD Six focus groups were conducted, supplemented by one-on-one interviews, with 29 healthcare providers, managers, and policymakers in primary care, palliative care, and geriatric care. Participants were purposively sampled to achieve maximal variation. Data were analysed using a constant comparative approach. RESULTS Six themes were prevalent across the dataset: early identification is aligned with the values, aims, and positioning of primary care; providers have concerns about what to do after identification; how we communicate about the end of life requires change; early identification and subsequent conversations require an integrated team approach; for patients, early identification will have implications beyond medical care; and a public health approach is needed to optimise early identification and its impact. CONCLUSION Stakeholders were much more concerned with how primary care providers would navigate the post-identification period than with early identification itself. Implications of early identification include the need for a team-based approach to identification and to engage broader communities to ensure people live and die well post-identification.
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Smith MB, Macieira TGR, Bumbach MD, Garbutt SJ, Citty SW, Stephen A, Ansell M, Glover TL, Keenan G. The Use of Simulation to Teach Nursing Students and Clinicians Palliative Care and End-of-Life Communication: A Systematic Review. Am J Hosp Palliat Care 2018. [PMID: 29514480 PMCID: PMC6039868 DOI: 10.1177/1049909118761386] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives: To present the findings of a systematic review on the use of simulation-based learning experiences (SBLEs) to teach communication skills to nursing students and clinicians who provide palliative and end-of-life care to patients and their families. Background: Palliative care communication skills are fundamental to providing holistic patient care. Since nurses have the greatest amount of direct exposure to patients, building such communication competencies is essential. However, exposure to patients and families receiving palliative and end-of-life care is often limited, resulting in few opportunities to learn these skills in the clinical setting. Simulation-based learning experiences can be used to supplement didactic teaching and clinical experiences to build the requisite communication skills. Methods: Searches of CINAHL, MEDLINE, PsychINFO, ERIC, and Web of Science electronic databases and Grey Literature returned 442 unique records. Thirty articles met the established criteria, including the SBLE must contain a nursing role. Results: Simulation-based learning experience are being used to teach palliative and end-of-life communication skills to nursing students and clinicians. Lack of standardization, poor evaluation methods, and limited exposure to the entire interprofessional team makes it difficult to identify and disseminate validated best practices. Conclusion: While the need for further research is acknowledged, we recommend this evidence be augmented by training programs that utilize SBLEs through (1) applying standards, (2) clearly specifying goals and objectives, (3) integrating externally validated scenarios, and (4) employing rigorous evaluation methods and measures that link the SBLE to the training objectives and desired clinician practice behaviors and patient outcomes.
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Affiliation(s)
- Madison B Smith
- 1 College of Nursing, University of Florida, Gainesville, FL, USA
| | | | - Michael D Bumbach
- 2 College of Nursing, Family, Community, and Health System Science, University of Florida, Gainesville, FL, USA
| | | | - Sandra W Citty
- 2 College of Nursing, Family, Community, and Health System Science, University of Florida, Gainesville, FL, USA
| | - Anita Stephen
- 4 College of Nursing, Biobehavioral Nursing Science, University of Florida, Gainesville, FL, USA
| | - Margaret Ansell
- 5 Health Science Center Libraries, University of Florida, Gainesville, FL, USA
| | - Toni L Glover
- 4 College of Nursing, Biobehavioral Nursing Science, University of Florida, Gainesville, FL, USA
| | - Gail Keenan
- 2 College of Nursing, Family, Community, and Health System Science, University of Florida, Gainesville, FL, USA
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Abstract
End-of-life care (EoLC) should be seen as everyone's business in acute hospital settings; a focus on targeted education and training in EoLC has the potential to improve the delivery of care for, and experiences of, patients and their families. We discuss the challenges associated with providing EoLC education in acute settings, and make recommendations around what should be delivered, to whom, when and how, including the measurement of impact of educational interventions. To deliver excellent education, content and delivery needs to be multifaceted, tailored to the needs of staff, and, importantly, led by the voices of patients and their families. We call on senior trust executives to resource and support the development and delivery of an EoLC education strategy to improve competencies of all staff, fostering an organisational culture of person-centred EoLC throughout any acute setting.
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Affiliation(s)
- Sarah Cox
- Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Lisa Jane Brighton
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Sarah Russell
- Hospice UK, London, UK and visiting fellow, University of Southampton, Southampton, UK
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Brighton LJ, Selman LE, Gough N, Nadicksbernd JJ, Bristowe K, Millington-Sanders C, Koffman J. 'Difficult Conversations': evaluation of multiprofessional training. BMJ Support Palliat Care 2017; 8:45-48. [PMID: 29118100 PMCID: PMC5867425 DOI: 10.1136/bmjspcare-2017-001447] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 10/18/2017] [Indexed: 11/18/2022]
Abstract
Objectives Evidence-based communication skills training for health and social care professionals is essential to improve the care of seriously ill patients and their families. We aimed to evaluate the self-reported impact of ‘Difficult Conversations’, a multidisciplinary half-day interactive workshop, and gain feedback to inform future development and evaluation. Methods Service evaluation using questionnaire data collected before and immediately after workshops from February 2015 to August 2016 regarding participant self-assessed confidence, knowledge and skills. Qualitative free-text comments provided feedback about the workshop and were subjected to content analysis. Results Of 886 workshop participants, 655 completed baseline questionnaires and 714 postworkshop questionnaires; 550 were matched pairs. Participants were qualified or trainee general practitioners (34%), community nurses and care coordinators (32%), social care professionals (7%), care home staff (6%), advanced practice/specialist nurses (5%), care workers (5%) and allied health professionals (3%). All groups demonstrated significant increases in mean self-assessed confidence (2.46, 95% CI 2.41 to 2.51; to 3.20, 95% CI 3.17 to 3.24; P<0.001), knowledge (2.22, 95% CI 2.17 to 2.27; to 3.18, 95% CI 3.14 to 3.22; P<0.001) and skills (2.37, 95% CI 2.32 to 2.42; to 3.09, 95% CI 3.05 to 3.12; P<0.001). Qualitative findings showed participants valued role play, the communication framework acronym and opportunities for discussion. They commended workshop facilitators’ skills, the safe atmosphere and interprofessional learning. Suggested improvements included more prepared role play and greater coverage of the taught topics. Conclusions ‘Difficult Conversations’ workshops were associated with improvements in participants’ self-assessed confidence, knowledge, and skills. Our findings identify workshop characteristics that are acceptable to multidisciplinary trainees. Further testing is warranted to determine effectiveness and accurately identify workshop components leading to change.
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Affiliation(s)
- Lisa Jane Brighton
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Lucy Ellen Selman
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK.,Population HealthSciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nicholas Gough
- Department of Palliative Care, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
| | | | - Katherine Bristowe
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | | | - Jonathan Koffman
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
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Selman LE, Brighton LJ, Hawkins A, McDonald C, O'Brien S, Robinson V, Khan SA, George R, Ramsenthaler C, Higginson IJ, Koffman J. The Effect of Communication Skills Training for Generalist Palliative Care Providers on Patient-Reported Outcomes and Clinician Behaviors: A Systematic Review and Meta-analysis. J Pain Symptom Manage 2017; 54:404-416.e5. [PMID: 28778560 DOI: 10.1016/j.jpainsymman.2017.04.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 04/10/2017] [Indexed: 01/09/2023]
Abstract
CONTEXT As most end-of-life care is provided by health care providers who are generalists rather than specialists in palliative care, effective communication skills training for generalists is essential. OBJECTIVES To determine the effect of communication training interventions for generalist palliative care providers on patient-reported outcomes and trainee behaviors. METHODS Systematic review from searches of 10 databases to December 2015 (MEDLINE, EMBASE, PsycINFO, ERIC, CINAHL, CENTRAL, Web of Science, ICTRP, CORDIS, and OpenGrey) plus hand searching. Randomized controlled trials of training interventions intended to enhance generalists' communication skills in end-of-life care were included. Two authors independently assessed eligibility after screening, extracted data, and graded quality. Data were pooled for meta-analysis using a random-effects model. PRISMA guidelines were followed. RESULTS Nineteen of 11,441 articles were eligible, representing 14 trials. Eleven were included in meta-analyses (patients n = 3144, trainees n = 791). Meta-analysis showed no effect on patient outcomes (standardized mean difference [SMD] = 0.10, 95% CI -0.05 to 0.24) and high levels of heterogeneity (chi-square = 21.32, degrees of freedom [df] = 7, P = 0.003; I2 = 67%). The effect on trainee behaviors in simulated interactions (SMD = 0.50, 95% CI 0.19-0.81) was greater than in real patient interactions (SMD = 0.21, 95% CI -0.01 to 0.43) with moderate heterogeneity (chi-square = 8.90, df = 5, P = 0.11; I2 = 44%; chi-square = 5.96, df = 3, P = 0.11; I2 = 50%, respectively). Two interventions with medium effects on showing empathy in real patient interactions included personalized feedback on recorded interactions. CONCLUSIONS The effect of communication skills training for generalists on patient-reported outcomes remains unclear. Training can improve clinicians' ability to show empathy and discuss emotions, at least in simulated consultations. Personalized feedback on recorded patient interactions may be beneficial. REGISTRATION NUMBER CRD42014014777.
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Affiliation(s)
- Lucy Ellen Selman
- King's College London, Cicely Saunders Institute, London, United Kingdom; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
| | - Lisa J Brighton
- King's College London, Cicely Saunders Institute, London, United Kingdom
| | - Amy Hawkins
- Phyllis Tuckwell Hospice, Farnham, United Kingdom; Frimley Park Hospital NHS Foundation Trust, Frimley, United Kingdom
| | - Christine McDonald
- King's College London, Cicely Saunders Institute, London, United Kingdom
| | - Suzanne O'Brien
- King's College London, Cicely Saunders Institute, London, United Kingdom
| | - Vicky Robinson
- King's College London, Cicely Saunders Institute, London, United Kingdom
| | - Shaheen A Khan
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Rob George
- King's College London, Cicely Saunders Institute, London, United Kingdom; St Christopher's Hospice, London, United Kingdom
| | | | - Irene J Higginson
- King's College London, Cicely Saunders Institute, London, United Kingdom
| | - Jonathan Koffman
- King's College London, Cicely Saunders Institute, London, United Kingdom
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