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López-García M, Rubio L, Martin-de-Las-Heras S, Suárez J, Pérez-Cárceles MD, Martin-Martin J. Instruments to measure skills and knowledge of physicians and medical students in palliative care: A systematic review of psychometric properties. MEDICAL TEACHER 2022; 44:1133-1145. [PMID: 35486883 DOI: 10.1080/0142159x.2022.2067033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Palliative care is constantly increasing around the world. The knowledge and skills of future physicians in this area are crucial. This study evaluates the psychometric properties of knowledge and skills questionnaires used in palliative care, validated by physicians or medical students based on the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. METHODS A systematic review was carried out in Cosmin Databases, Cochrane Library, PsycINFO, SciELO, Cinahl, and Medline up to September 2020 (updated June 2021), based on the COSMIN methodology and PRISMA recommendations. The psychometric properties of each included questionnaire were identified. Methodological quality, quality of results, and quality of evidence were evaluated. RESULTS The search strategy yielded 12 questionnaires assessing the knowledge and skills of physicians or medical students. The Palliative Care Knowledge Questionnaire for PEACE (PEACE-Q) and Palliative Care Knowledge Test (PCKT) were the instruments with the highest scores for methodological quality, quality of results, and quality of evidence-based on the COSMIN methodology. CONCLUSIONS PEACE-Q and PCKT should be the preferred choice to assess palliative care knowledge and skills in physicians. In-depth studies following COSMIN validation criteria are recommended to improve the psychometric properties and cross-cultural validation of the questionnaires.
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Affiliation(s)
- Mónica López-García
- Cudeca Hospice (Palliative Care Foundation), Málaga, Spain
- Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
| | - Leticia Rubio
- Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
- Department of Legal Medicine, Facultad de Medicina, Universidad de Málaga, Málaga, Spain
| | - Stella Martin-de-Las-Heras
- Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
- Department of Legal Medicine, Facultad de Medicina, Universidad de Málaga, Málaga, Spain
| | - Juan Suárez
- Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
- Department of Legal Medicine, Facultad de Medicina, Universidad de Málaga, Málaga, Spain
| | - María D Pérez-Cárceles
- Department of Legal and Forensic Medicine, Faculty of Medicine, Biomedical Research Institute (IMIB-Arrixaca), University of Murcia, Murcia, Spain
| | - Jaime Martin-Martin
- Cudeca Hospice (Palliative Care Foundation), Málaga, Spain
- Department of Legal Medicine, Facultad de Medicina, Universidad de Málaga, Málaga, Spain
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2
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Soikkeli‐Jalonen A, Stolt M, Hupli M, Lemetti T, Kennedy C, Kydd A, Haavisto E. Instruments for assessing nurses’ palliative care knowledge and skills in specialised care setting: An integrative review. J Clin Nurs 2020; 29:736-757. [DOI: 10.1111/jocn.15146] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/12/2019] [Accepted: 11/24/2019] [Indexed: 12/29/2022]
Affiliation(s)
| | - Minna Stolt
- Department of Nursing Science Finland and Researcher Turku University Hospital University of Turku Turku Finland
| | - Maija Hupli
- Department of Nursing Science University of Turku Turku Finland
| | - Terhi Lemetti
- Department of Nursing Science Helsinki University Hospital University of Turku Turku Finland
| | - Catriona Kennedy
- School of Nursing and Midwifery Robert Gordon University Aberdeen UK
- Department of Nursing and Midwifery The University of Limerick Limerick Ireland
| | - Angela Kydd
- School of Nursing and Midwifery Robert Gordon University Aberdeen UK
| | - Elina Haavisto
- Department of Nursing Science Satakunta Central Hospital University of Turku Turku Finland
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Abstract
BACKGROUND Palliative care clinicians frequently encounter situations in which there are ethical dilemmas about the right thing to do. Palliative medicine fellowships are required to include education about ethics. Our fellowship increased fellows' ethics education through monthly didactics, lectures in a professional development series, and a month-long ethics rotation. METHODS We sought input from graduates of our palliative medicine fellowship about the content and amount of the ethics education they received. Fellowship graduates were invited via e-mail to complete an online survey about the ethics education they received during fellowship. They were asked questions about their work environment, frequency with which they encounter ethical dilemmas, their perspectives on the ethics content, the amount of ethics education they received during fellowship, and their input on ways to improve the ethics education within the fellowship. RESULTS Twenty-eight (82%) of 34 fellowship graduates completed the survey; 93% noted that they encounter ethical dilemmas in their work, with half encountering these on a daily or weekly basis, and 86% noted that colleagues ask them questions about ethics because of their palliative medicine training. None responded that they had received too much ethics education. Fellowship graduates identified ethics content that has been useful since completing fellowship and suggested ways to improve ethics education for future fellows. CONCLUSION Graduates of a palliative medicine fellowship encounter ethical dilemmas often and frequently are asked questions about ethics. Palliative medicine fellowships may want to examine their ethics curriculum to ensure that graduating fellows are learning about relevant ethics topics and are comfortable discussing ethical dilemmas with others.
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Affiliation(s)
- Elizabeth K Vig
- 1 Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.,2 Geriatrics and Extended Care, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Susan E Merel
- 3 Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
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Andersson E, Salickiene Z, Rosengren K. To be involved - A qualitative study of nurses' experiences of caring for dying patients. NURSE EDUCATION TODAY 2016; 38:144-149. [PMID: 26689734 DOI: 10.1016/j.nedt.2015.11.026] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 11/20/2015] [Accepted: 11/25/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The aim of this study was to describe nurses' experiences (>two years) of caring for dying patients in surgical wards. BACKGROUND Palliative care is included in education for nurses. However, the training content varies, and nurse educators need to be committed to the curriculum regarding end-of-life situations. A lack of preparation among newly graduated nurses regarding dying and death could lead to anxiety, stress and burnout. Therefore, it is important to improve knowledge regarding end-of-life situations. SETTING, PARTICIPANTS AND METHOD A qualitative descriptive study was carried out in two surgical wards in the southern part of Sweden. The study comprised six interviews with registered nurses and was analysed using manifest qualitative content analysis, a qualitative method that involves an inductive approach, to increase our understanding of nurses' perspectives and thoughts regarding dying patients. RESULTS The results formed one category (caring-to be involved) and three subcategories (being supportive, being frustrated and being sensitive in the caring processes). Nurses were personally affected and felt unprepared to face dying patients due to a lack of knowledge about the field of palliative care. Their experiences could be described as processes of transition from theory to practice by trial and error. CONCLUSION Supervision is a valuable tool for bridging the gap between theory and practice in nursing during the transition from novice to expert. Improved knowledge about palliative care during nursing education and committed nursing leadership at the ward level facilitate preparation for end-of-life situations.
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Affiliation(s)
- Erika Andersson
- Department of Surgery, Norra Älvsborg County Hospital, SE-461 85 Trollhättan, Sweden.
| | - Zivile Salickiene
- Department of Surgery, Sahlgrenska University Hospital, SE-41345 Gothenburg, Sweden.
| | - Kristina Rosengren
- Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, SE-405 30 Gothenburg, Sweden.
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St-Martin L, Harripaul A, Antonacci R, Laframboise D, Purden M. Advanced Beginner to Competent Practitioner: New Graduate Nurses’ Perceptions of Strategies That Facilitate or Hinder Development. J Contin Educ Nurs 2015; 46:392-400; quiz 401-2. [DOI: 10.3928/00220124-20150821-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 05/21/2015] [Indexed: 11/20/2022]
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Rubio RDC. El enfermo crónico en la fase final de su enfermedad en Cuidado Intensivo requiere la transición del cuidado curativo al cuidado paliativo. Revisión de la literatura. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.acci.2015.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sanchez-Reilly S, Ross JS. Hospice and palliative medicine: curriculum evaluation and learner assessment in medical education. J Palliat Med 2012; 15:116-22. [PMID: 22268408 DOI: 10.1089/jpm.2011.0155] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Major efforts have been pursued to improve palliative care education for physicians at all levels of their training. Such changes include the incorporation of palliative care curriculum and guidelines, an established process for competency-based evaluation and certification, faculty development, innovative educational experiences, the improvement of textbooks, and the establishment of accredited palliative medicine fellowships. Hospice and palliative medicine (HPM) has been clearly defined as a subspecialty and a crucial area of medical education. As innovative curricular approaches have become available to educate medical and other interprofessional trainees, this article aims to describe different models and methods applied in curriculum evaluation, tailoring such approaches to the field of palliative medicine. A stepwise process of curriculum development and evaluation is described, focusing on available curriculum evaluation competency-based tools for each level of learners. As HPM evolves and its educational programs grow, curriculum evaluation will provides invaluable feedback to institutions and programs in many ways.
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Affiliation(s)
- Sandra Sanchez-Reilly
- Division of Geriatrics, Gerontology and Palliative Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA.
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Meier DE. Increased access to palliative care and hospice services: opportunities to improve value in health care. Milbank Q 2011; 89:343-80. [PMID: 21933272 PMCID: PMC3214714 DOI: 10.1111/j.1468-0009.2011.00632.x] [Citation(s) in RCA: 245] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
CONTEXT A small proportion of patients with serious illness or multiple chronic conditions account for the majority of health care spending. Despite the high cost, evidence demonstrates that these patients receive health care of inadequate quality, characterized by fragmentation, overuse, medical errors, and poor quality of life. METHODS This article examines data demonstrating the impact of the U.S. health care system on clinical care outcomes and costs for the sickest and most vulnerable patients. It also defines palliative care and hospice, synthesizes studies of the outcomes of palliative care and hospice services, reviews variables predicting access to palliative care and hospice services, and identifies those policy priorities necessary to strengthen access to high-quality palliative care. FINDINGS Palliative care and hospice services improve patient-centered outcomes such as pain, depression, and other symptoms; patient and family satisfaction; and the receipt of care in the place that the patient chooses. Some data suggest that, compared with the usual care, palliative care prolongs life. By helping patients get the care they need to avoid unnecessary emergency department and hospital stays and shifting the locus of care to the home or community, palliative care and hospice reduce health care spending for America's sickest and most costly patient populations. CONCLUSIONS Policies focused on enhancing the palliative care workforce, investing in the field's science base, and increasing the availability of services in U.S. hospitals and nursing homes are needed to ensure equitable access to optimal care for seriously ill patients and those with multiple chronic conditions.
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Affiliation(s)
- Diane E Meier
- Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA.
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Leon M, Florez S, De Lima L, Ryan K. Integrating palliative care in public health: the Colombian experience following an international pain policy fellowship. Palliat Med 2011; 25:365-9. [PMID: 21228093 DOI: 10.1177/0269216310385369] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Access to palliative care is insufficient in many countries around the world. In an effort to improve access to palliative care services and treatments, a public health approach as suggested by the World Health Organization was implemented in Colombia to improve opioid availability, increase awareness and competences about palliative care for healthcare workers, and to include palliative care as a component of care in legislation. As a result, opioid availability has improved, a mandatory palliative care course for medical undergraduate students has been implemented and a palliative care law is being discussed in the Senate. This article describes the strategy, main achievements and suggestions for implementing similar initiatives in developing countries.
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Affiliation(s)
- Marta Leon
- Universidad de la Sabana, Pain and Palliative Care Unit, Autopista Norte Km 21, Campus Puente del Comun, Chia, Columbia
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O'Connor M, Fisher C, French L, Halkett G, Jiwa M, Hughes J. Exploring the community pharmacist's role in palliative care: focusing on the person not just the prescription. PATIENT EDUCATION AND COUNSELING 2011; 83:458-464. [PMID: 21621942 DOI: 10.1016/j.pec.2011.04.037] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 04/21/2011] [Accepted: 04/28/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Changes in health care provision have led to an emphasis on providing end of life care within the home. community pharmacists are well positioned to provide services to community-based palliative care patients and carers. METHODS A multiple qualitative case study design was adopted. A total of 16 focus groups and 19 interviews with pharmacists, nurses, general practitioners and carers were undertaken across metropolitan and regional settings in Western Australia, New South Wales, Queensland and Victoria. Data were analysed thematically using a framework that allowed similarities and differences across stakeholder groups and locations to be examined and compared. RESULTS Three main themes emerged: effective communication; challenges to effective communication; and: towards best practice, which comprised two themes: community pharmacists' skills and community pharmacists' needs. DISCUSSION A key component of the provision of palliative care was having effective communication skills. Although community pharmacists saw an opportunity to provide interpersonal support, they suggested that they would need to develop more effective communication skills to fulfil this role. CONCLUSION There is clear need for continuing professional development in this area - particularly in communicating effectively and managing strong emotions. PRACTICE IMPLICATIONS Community pharmacists are willing to support palliative care patients and carers but need education, support and resources.
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Affiliation(s)
- Moira O'Connor
- Curtin Health Innovation Research Institute, Curtin University, Perth WA, Australia.
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A Community Partnership Approach to Building and Empowering a Palliative Care Resource Nurse Team. J Hosp Palliat Nurs 2011. [DOI: 10.1097/njh.0b013e3181ff0bf8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Starr J. ASSOCIATION BETWEEN ADVANCE DIRECTIVES AND QUALITY OF END-OF-LIFE CARE: A NATIONAL STUDY. J Am Geriatr Soc 2008; 56:168. [DOI: 10.1111/j.1532-5415.2007.01587.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Collins LG, Parks SM, Winter L. The state of advance care planning: one decade after SUPPORT. Am J Hosp Palliat Care 2007; 23:378-84. [PMID: 17060305 DOI: 10.1177/1049909106292171] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment (SUPPORT) was a landmark study regarding end-of-life decision making and advance care planning. Phase I of the study looked at the state of end of life in various hospitals, and phase II implemented a nurse-facilitated intervention designed to improve advance care planning, patient-physician communication, and the dying process. The observational phase found poor quality of care at the end of life and the intervention failed to improve the targeted outcomes. The negative findings brought public attention to the need to improve care for the dying and spawned a wealth of additional research on decision-making at the end of life. In the decade since SUPPORT, researchers have defined the attributes of a "good death," addressed the role of advance directives in advance care planning, and studied the use of surrogate decision-making at the end of life. This rekindled the discussion on advance care planning and challenged health care providers to design more flexible approaches to end of life care.
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Affiliation(s)
- Lauren G Collins
- Department of Family and Community Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
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Abstract
Dying patients and their families often have unique physical, psychosocial, social, and spiritual needs that require special ized end-of-life (EOL) skills. EOL preparation of nurses has been inconsistent. Novice nurses need guidance to develop the knowledge, clinical skills, and coping strategies to provide high-quality and compassionate EOL care. Inadequate preparation for providing EOL care can lead to anxiety, stress, and burnout. Barriers that prevent adequate preparation and support of novice nurses in EOL care include lack of education, financial constraints, poor staffing, and major life changes. However, opportunities are available to support novice oncology nurses as they develop the skills necessary to provide competent EOL care. Nurse extern programs and individually tailored orientation plans that include EOL care should be developed. Careful selection of mentors and preceptors is an important aspect in planning orientation for novice oncology nurses. The presence of peers experienced in EOL care is crucial. Educational materials, standards of practice, and continuing education on EOL care should be available to novice nurses as well. EOL competencies may provide a blueprint to help with performance evaluations. Adequate preparation of novice oncology nurses for EOL care will improve patient outcomes, increase job satisfaction, and promote longevity in the specialty.
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