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Felber SJ, Zambrano SC, Guffi T, Schmitz FM, Brem BG, Schnabel KP, Guttormsen S, Eychmüller S. How to talk about dying? The development of an evidence-based model for communication with patients in their last days of life and their family caregivers. PEC INNOVATION 2024; 5:100309. [PMID: 39027227 PMCID: PMC11254737 DOI: 10.1016/j.pecinn.2024.100309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 06/06/2024] [Accepted: 06/17/2024] [Indexed: 07/20/2024]
Abstract
Objective To help healthcare professionals (HCP) act with more confidence when communicating about approaching death, we sought to develop a communication model for HCP to facilitate conversations with dying patients and family caregivers (FC) in nonemergency situations. Methods We used a four-phase integrative approach: (1) creation of a preliminary model based on a systematic literature review and expert knowledge, (2) review of the model draft by international palliative care experts, (3) review by key stakeholders, and (4) final appraisal by communication experts. Results After the clinical recognition of dying, the communication model provides a structure and practical communication aids for navigating the conversation based on three phases. It describes the content and relational level as core dimensions of effective conversations about approaching death and highlights the importance of HCP self-awareness and self-care when caring for the dying. Conclusion Based on systematic involvement of key stakeholders, the model supports clinicians navigating challenging conversations about approaching death with dying patients and their FC successfully and with more confidence. Innovation This study expands the theoretical basis for communication about approaching death and offers a pragmatic model for educational interventions and clinical use.
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Affiliation(s)
- Sibylle J. Felber
- University Centre for Palliative Care (UZP), Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sofia C. Zambrano
- University Centre for Palliative Care (UZP), Bern University Hospital, University of Bern, Bern, Switzerland
- Institute for Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Tommaso Guffi
- Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Felix M. Schmitz
- Institute for Medical Education (IML), University of Bern, Bern, Switzerland
| | - Beate G. Brem
- Institute for Medical Education (IML), University of Bern, Bern, Switzerland
| | - Kai P. Schnabel
- Institute for Medical Education (IML), University of Bern, Bern, Switzerland
| | - Sissel Guttormsen
- Institute for Medical Education (IML), University of Bern, Bern, Switzerland
| | - Steffen Eychmüller
- University Centre for Palliative Care (UZP), Bern University Hospital, University of Bern, Bern, Switzerland
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Fortin Magaña M, Diaz S, Salazar-Colocho P, Feng A, López-Saca M. Long-term effects of an undergraduate palliative care course: a prospective cohort study in El Salvador. BMJ Support Palliat Care 2024; 14:200-207. [PMID: 33219104 DOI: 10.1136/bmjspcare-2020-002311] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 09/14/2020] [Accepted: 10/07/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND International organisations recommend the inclusion of palliative care undergraduate education as a way to meet increasing demand; the long-term effects, however, are unknown. Since 2013 the Dr José Matías Delgado University has offered an undergraduate course for palliative care. AIMS To assess whether a palliative care course results in improvement in self-perceived comfort among students and if it lasts up to 4 years later; and to examine students' knowledge of palliative care and assess the relationship between comfort and knowledge. DESIGN This is a prospective cohort study where students attending the course were requested to complete the Scale of Self-Perceived Comfort in palliative care pre and post course. Participants were contacted in 2018 and a group without palliative care education was established as a control group, matched one-to-one according to current academic level. They were asked to complete the Scale of Self-Perceived Comfort questionnaire together with the Palliative Care Knowledge Test. SETTINGS/PARTICIPANTS 83 students who attended the course between the years 2014 and 2017 and 101 controls. RESULTS In the postcourse test, participants had a 1.13-point increase (p≤0.001) in comfort, which persisted 4 years later and was superior to the control group by 0.6 points (p≤0.001). The control group showed no difference in the precourse test despite having more clinical experience (p=0.68). The students outscored the control group in the knowledge test by 4.2 points (p≤0.001). There appears to be no correlation between comfort and knowledge. CONCLUSION A palliative care undergraduate course results in improvement in student comfort and knowledge which persists up to 4 years later.
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Affiliation(s)
- Miguel Fortin Magaña
- Palliative Medicine, Dr Jose Matias Delgado University, San Salvador, El Salvador
| | - Susana Diaz
- Palliative Medicine, Dr Jose Matias Delgado University, San Salvador, El Salvador
| | | | - Ancu Feng
- Palliative Medicine, Dr Jose Matias Delgado University, San Salvador, El Salvador
| | - Mario López-Saca
- Palliative Medicine, Dr Jose Matias Delgado University, San Salvador, El Salvador
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3
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Shaulov A, Finkelstein A, Vashdi I, DeKeyser Ganz F, Kienski Woloski-Wruble A, Rubinstein E, Marcus EL, Lesser L, Shaham D. Interprofessional palliative and end-of-life education: short-term and long-term outcomes - mixed-methods analysis. BMJ Support Palliat Care 2023:spcare-2023-004290. [PMID: 37258087 DOI: 10.1136/spcare-2023-004290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/17/2023] [Indexed: 06/02/2023]
Abstract
ObjectiveInterprofessional care is integral to end-of-life (EOL) and palliative care (PC) and may be suited for EOL and PC education.We evaluate the impact of an interprofessional EOL care curriculum on participants, during the course, on completion and 4 years laterusing quantitative (questionnaires) and qualitative (open-ended questions and interviews) methods.The course included 14 fifth and sixth-year medical students, 9 social work students and 7 nursing students enrolled in master's degree programmes. Seventeen participants completed questionnaires 4 years later and eight participated in interviews.On postcourse questionnaires, participants attributed high value to interprofessional education (IPE) (4.77/5±0.50 on a Likert scale). Four years later, participants reported that IPE impacted their professional (3.65/5±1.11) and personal lives (3.94/5±1.09) and found PC IPE important (4.88/5±0.33).Conventional content analysis showed that the course enabled discussion of death and dying and provided an opportunity for a personal-emotional journey. It offered an approach to EOL care and an opportunity to experience interprofessional teamwork at the EOL resulting in behavioural change.Interprofessional EOL education resulted in meaningful and lasting self-reported personal and professional behavioural outcomes.
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Affiliation(s)
- Adir Shaulov
- Department of Hematology, Hadassah Medical Center and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Adi Finkelstein
- Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel
| | - Inon Vashdi
- School of Medicine, Hadassah and Hebrew University, Jerusalem, Israel
| | - Freda DeKeyser Ganz
- Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel
- Henrietta Szold-Hadassah-Hebrew University School of Nursing in the Faculty of Medicine, Jerusalem, Israel
| | | | | | - Esther-Lee Marcus
- Department of Geriatrics, Herzog Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Lior Lesser
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dorith Shaham
- Department of Radiology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Kukimoto Y, Maeda K, Yasui N, Nakamura M. Impact of Palliative and End of Life Care Interprofessional Education for Pre-licensure Healthcare Students: An Integrated Review. Am J Hosp Palliat Care 2023; 40:202-215. [PMID: 35711094 DOI: 10.1177/10499091221108344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
An accelerating aging society and rise in serious illnesses has led to an increase in deaths and made the demand for palliative care even greater. An integrated review was conducted to identify the impact of interprofessional education (IPE) on palliative/end of life (EOL) care for unlicensed health care students with a multidisciplinary approach. The databases searched included MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Education Resources Information Center (ERIC), PsycINFO, and the Cochrane Library's CENTRAL. Fifteen studies were included. Participants' disciplines included medicine, nursing, pharmacy, physical therapy, occupational therapy, social work, chaplain, public health and psychology. Nine were pre-post design and others were post course evaluations. One research study was an interventional trial with a comparative group. The selected studies included a variety of teaching strategies such as simulation or role play, clinical experience, case study, and TOSCE training. The importance of an interprofessional approach to palliative/EOL care has been highlighted, and our review suggests that combined IPE and palliative/EOL interventions can potentially impact palliative/EOL patient outcomes. More studies are needed to clarify the effectiveness of interprofessional palliative/EOL educational interventions including facilitators, learning outcomes, variable methods or teaching strategy, and the level of students.
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Affiliation(s)
- Yukiko Kukimoto
- School of Nursing, 97810Morinomiya University of Medical Sciences, Osaka, Japan
| | - Kaou Maeda
- School of Physical Therapy, 97810Morinomiya University of Medical Sciences, Osaka, Japan
| | - Nagisa Yasui
- School of Nursing, 97810Morinomiya University of Medical Sciences, Osaka, Japan
| | - Megumi Nakamura
- School of Occupational Therapy, 97810Morinomiya University of Medical Sciences, Osaka, Japan
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Heath L, Egan R, Iosua E, Walker R, Ross J, MacLeod R. Palliative and end of life care in undergraduate medical education: a survey of New Zealand medical schools. BMC MEDICAL EDUCATION 2022; 22:530. [PMID: 35804380 PMCID: PMC9264288 DOI: 10.1186/s12909-022-03593-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 06/22/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND In New Zealand, 34% of deaths occur in the hospital setting where junior doctors are at the frontline of patient care. The death rate in New Zealand is expected to double by 2068 due to the aging population, but many studies report that graduates feel unprepared to care for people near the end of life and find this to be one of the most stressful parts of their work. International guidelines recommend that palliative and end of life care should be a mandatory component of undergraduate medical education, yet teaching varies widely and remains optional in many countries. Little is known about how medical students in New Zealand learn about this important area of clinical practice. The purpose of this study was to investigate the organisation, structure and provision of formal teaching, assessment and clinical learning opportunities in palliative and end of life care for undergraduate medical students in New Zealand. METHODS Quantitative descriptive, cross-sectional survey of module conveners in New Zealand medical schools. RESULTS Palliative and end of life care is included in undergraduate teaching in all medical schools. However, there are gaps in content, minimal formal assessment and limited contact with specialist palliative care services. Lack of teaching staff and pressure on curriculum time are the main barriers to further curriculum development. CONCLUSIONS This article reports the findings of the first national survey of formal teaching, assessment and clinical learning opportunities in palliative and end of life care in undergraduate medical education in New Zealand. There has been significant progress towards integrating this content into the curriculum, although further development is needed to address barriers and maximise learning opportunities to ensure graduates are as well prepared as possible.
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Affiliation(s)
- Lis Heath
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Richard Egan
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Ella Iosua
- Biostatistics Centre, University of Otago, Dunedin, New Zealand
| | - Robert Walker
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Jean Ross
- School of Nursing, Otago Polytechnic, Dunedin, New Zealand
| | - Rod MacLeod
- School of Population Health, University of Auckland, Auckland, New Zealand
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Thyson T, Schallenburger M, Scherg A, Leister A, Schwartz J, Neukirchen M. Communication in the face of death and dying - how does the encounter with death influence the patient management competence of medical students? An outcome-evaluation. BMC MEDICAL EDUCATION 2022; 22:25. [PMID: 35012542 PMCID: PMC8744229 DOI: 10.1186/s12909-021-03060-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 11/30/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND INFORMATION As part of an elective course, the Interdisciplinary Centre for Palliative Medicine at Duesseldorf University Hospital offers medical students the opportunity to personally meet and talk to a seriously ill patient on one or more occasions. The future physicians are provided with an opportunity to broaden their professional competence, i.e. their knowledge and skills in patient-centred communication at the end of life, and enhance their personal competence, for example in how to professionally handle their own emotions. A topical e-learning module helps the students to prepare for the meetings, and writing a reflection paper forms the basis for the concluding reflection seminar. OBJECTIVES The study's objective is a global and outcome-based evaluation of the elective blended-learning course that provides real-world patient interaction. The outcome-based evaluation or outcome assessment aims to objectively evaluate changes identified in knowledge, skills and attitude among the participants of the elective-course. Furthermore, the evaluation aims to answer the question of whether changes especially in attitude (social skills and self-competence) should be expected after the students have met with severely ill or dying patients. METHOD On two questionnaires specifically developed for this survey the students were able to provide a global rating of the elective course and describe their learning gains in palliative care. The students' learning gains were measured by means of 14 items reflecting the specific educational objectives of the offered elective course. Using the German school grading system as a rating scale, the students assessed their learning progress by retrospectively evaluating their skills before and after completion of the elective course (Comparative Self-Assessment, CSA). RESULTS In the time from April 2018 till March 2020, 62 students participated in the evaluation. Overall, learning progress among students could be observed across all areas of competence, and in 50% of all retrospective self-assessment items the learning gains were ≥ 50%. The highest learning gain (63.6%) was observed in the students' ability to meet a severely ill patient without fear. The lowest learning gain was observed when students had to confront and accept their own mortality. CONCLUSIONS The offered elective course supports students in achieving social and self-competence development goals. According to the obtained results, contact with real-world patients helps mould the students' attitude.
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Affiliation(s)
- T Thyson
- Interdisciplinary Centre of Palliative Care, University Hospital, Heinrich Heine University, Duesseldorf, Germany.
- University Hospital Duesseldorf, Interdisciplinary Centre for Palliative Medicine, Moorenstr. 5, 40225, Duesseldorf, Germany.
| | - M Schallenburger
- Interdisciplinary Centre of Palliative Care, University Hospital, Heinrich Heine University, Duesseldorf, Germany.
- University Hospital Duesseldorf, Interdisciplinary Centre for Palliative Medicine, Moorenstr. 5, 40225, Duesseldorf, Germany.
| | - A Scherg
- Interdisciplinary Centre of Palliative Care, University Hospital, Heinrich Heine University, Duesseldorf, Germany
| | - A Leister
- Interdisciplinary Centre of Palliative Care, University Hospital, Heinrich Heine University, Duesseldorf, Germany
| | - J Schwartz
- Interdisciplinary Centre of Palliative Care, University Hospital, Heinrich Heine University, Duesseldorf, Germany
| | - M Neukirchen
- Interdisciplinary Centre of Palliative Care, University Hospital, Heinrich Heine University, Duesseldorf, Germany
- Department of Anaesthesiology, University Hospital, Heinrich Heine University, Duesseldorf, Germany
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7
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Landers A, Wilkinson TJ. Spiralled Palliative Care Curriculum Aligned with International Guidelines Improves Self-Efficacy but Not Attitudes: Education Intervention Study. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2021; 12:1531-1538. [PMID: 35002352 PMCID: PMC8722720 DOI: 10.2147/amep.s338697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/10/2021] [Indexed: 06/14/2023]
Abstract
PURPOSE Despite recommendations that palliative care education should be in all health professional programmes, such education is ad-hoc and variable. To reduce variability, the European Association of Palliative Care (EAPC) published a comprehensive guideline for curricula development. This study evaluates a new palliative and end-of-life care course for medical undergraduates aligned with the EAPC guidelines, focusing on knowledge, skills and attitudes. METHODS Final-year medical students were surveyed using two validated questionnaires: Self Efficacy in Palliative Care (SEP-C) and Thanatophobia scale (TS). We compared the intervention group, that were exposed to an integrated palliative medicine course throughout the three clinical years, with a control group that were not exposed to the new educational intervention. RESULTS For self-efficacy, the intervention group had statistically significantly higher scores than the control arm. The control group had high scores compared with international data. Positive attitudes to dying patients were low and did not differ between the two groups. CONCLUSION A well-designed palliative and end-of-life curriculum that is aligned to EAPC guidelines increases the self-efficacy of medical students in managing palliative patients but has little effect on attitudes to dying people. This is likely to be influenced by other factors such as the need for experiential learning.
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Affiliation(s)
- Amanda Landers
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Tim J Wilkinson
- Department of Medicine, University of Otago, Christchurch, New Zealand
- Canterbury District Health Board, Christchurch, New Zealand
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Abstract
BACKGROUND Health science students in Spain should be trained to manage the process of death and dying. AIM To compare the perceptions, attitudes and fears of death from a sample of these students. METHODS This descriptive, cross-sectional and multi-centre study comprised 411 students studying degrees in medicine, nursing and physiotherapy. The variables used were the hospice-related death self-efficacy scale by Robbins and the Collet-Lester fear of death scale. FINDINGS The total score obtained on the death self-efficacy scale was 74.43/110, which is considered moderate to high self-efficacy for facing death. Facing the death of a friend at a young age obtained the lowest score (3.85±2.809). Regarding the Collet-Lester scale, the lowest score was 'fear of one's own death' (3.58±0.983) with a value of p=0.81. CONCLUSION The health science students who participated in this study displayed high levels of fear and anxiety towards death.
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Reigada C, Hermida-Romero S, Sandgren A, Gómez B, Olza I, Navas A, Centeno C. Interdisciplinary discussions on palliative care among university students in Spain: giving voice to the social debate. Int J Qual Stud Health Well-being 2021; 16:1955441. [PMID: 34353240 PMCID: PMC8354019 DOI: 10.1080/17482631.2021.1955441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND University students are the future professionals who will influence society. It is thus essential to improve students' understanding of palliative care (PC), especially those in the non-health field, to generate and encourage propitious opinions about PC. This study describes the perceptions of PC among university students from different disciplines. METHOD Qualitative exploratory study using virtual focus groups (FGs) and design thinking (DT) approach. An intentional sample of students from various disciplines, universities and cities from Spain were selected. Numerous researchers from different fields were involved in the discussion of the final thematic analysis. RESULTS Four themes and seven subthemes were found: i) Students have an ambiguous understanding about PC; ii) PC is not a common issue for non-health students; ii) Students see PC as an important and necessary field; iii) Students build counter-narratives against PC myths, demonstrating PC brings key benefits into people's lives; iv) PC is a synonym of death. CONCLUSION Despite the fact that students do not know much about PC, the topic easily arouses reflection and positive discussion. Through the conversations they find positive values and arguments against misunderstand- ing. Students from different disciplines could be the target of innovative educational initia- tives and the social debate on PC.
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Affiliation(s)
- Carla Reigada
- ATLANTES Research Group, Institute for Culture and Society, University of Navarra, Pamplona, Spain.,Navarra Institute for Health Research (Idisna), Pamplona, Spain
| | | | - Anna Sandgren
- Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Beatriz Gómez
- School of Communication, University of Navarra, Pamplona, Spain
| | - Inés Olza
- Emotional Culture and Identity Project, Institute for Culture and Society, University of Navarra, Pamplona, Spain
| | - Alejandro Navas
- School of Communication, University of Navarra, Pamplona, Spain
| | - Carlos Centeno
- ATLANTES Research Group, Institute for Culture and Society, University of Navarra, Pamplona, Spain.,Navarra Institute for Health Research (Idisna), Pamplona, Spain
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Mallon A, Hasson F, Casson K, Slater P, McIlfatrick S. Young adults understanding and readiness to engage with palliative care: extending the reach of palliative care through a public health approach: a qualitative study. BMC Palliat Care 2021; 20:120. [PMID: 34320961 PMCID: PMC8320215 DOI: 10.1186/s12904-021-00808-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/03/2021] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND Moving palliative care from a solely clinical focus to a more population based and community orientated approach is the hallmark of a much advocated public health approach to palliative care. Young adults are a vital cohort of the public, yet their understanding of palliative care has not been investigated. This study aimed to explore young adults' understanding of palliative care and identify factors that influence their engagement. METHODS A purposive sample of young adults (n = 24) aged 18-29 years were recruited from one UK University. Semi-structured interviews were undertaken face to face or via telephone or Skype between November 2017 and February 2018. Thematic analysis using a framework approach and underpinned by a socioecological perspective was used to analyse the interviews. RESULTS Three thematic categories were identified relating to intrapersonal and interpersonal influences, cultural and social influences and organisational and public policy influences. Palliative care was understood as supportive comfort care, delivered in the absence of cure, associated with the end of life and specifically focused on death and dying. Negative attitudes related to the context of care, which represented a static and hopeless situation. Whilst some reported positive attitudes, potential engagement was seen to be governed by a lack of knowledge and protective cultural norms. In terms of demonstrating readiness to engage with palliative care, participants requested clear information and suggested a normalising of palliative care through the education system. CONCLUSION Young adults in this study were ready to find out more about palliative care and identified social media as a platform upon which to engage this population. However, their perception of a society that views palliative care as a subject for those directly affected, creates a barrier to engagement. This study identified the ingredients of a public health message and mediums for disseminating the message. However, findings also suggest that a cultural shift is required to recognise the potential of engaging young adults in health issues that cross the life span, empowering them not only as individuals but as vital members of community and society.
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Affiliation(s)
- Anita Mallon
- Institute of Nursing and Health Research, School of Nursing, Ulster University, Shore Road, Newtownabbey, BT37 0QB Northern Ireland
| | - Felicity Hasson
- Institute of Nursing and Health Research, School of Nursing, Ulster University, Shore Road, Newtownabbey, BT37 0QB Northern Ireland
| | - Karen Casson
- Institute of Nursing and Health Research, School of Nursing, Ulster University, Shore Road, Newtownabbey, BT37 0QB Northern Ireland
| | - Paul Slater
- Institute of Nursing and Health Research, School of Nursing, Ulster University, Shore Road, Newtownabbey, BT37 0QB Northern Ireland
| | - Sonja McIlfatrick
- Institute of Nursing and Health Research, School of Nursing, Ulster University, Shore Road, Newtownabbey, BT37 0QB Northern Ireland
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Gryschek G, Cecilio-Fernandes D, Barros GAMD, Mason S, de Carvalho-Filho MA. Examining the effect of non-specialised clinical rotations upon medical students' Thanatophobia and Self-efficacy in Palliative Care: a prospective observational study in two medical schools. BMJ Open 2020; 10:e041144. [PMID: 33208334 PMCID: PMC7677329 DOI: 10.1136/bmjopen-2020-041144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 09/30/2020] [Accepted: 10/30/2020] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Including palliative care (PC) in overloaded medical curricula is a challenge, especially where there is a lack of PC specialists. We hypothesised that non-specialised rotations could provide meaningful PC learning when there are enough clinical experiences, with adequate feedback. OBJECTIVE Observe the effects of including PC topics in non-specialised placements for undergraduate medical students in two different medical schools. DESIGN Observational prospective study. SETTING Medical schools in Brazil. PARTICIPANTS 134 sixth-year medical students of two medical schools. METHODS This was a longitudinal study that observed the development of Self-efficacy in Palliative Care (SEPC) and Thanatophobia (TS) in sixth-year medical students in different non-specialised clinical rotations in two Brazilian medical schools (MS1 and MS2). We enrolled 78 students in MS1 during the Emergency and Critical Care rotation and 56 students in MS2 during the rotation in Anaesthesiology. Both schools provide PC discussions with different learning environment and approaches. PRIMARY OUTCOMES SEPC and TS Scales were used to assess students at the beginning and the end of the rotations. RESULTS In both schools' students had an increase in SEPC and a decrease in TS scores. CONCLUSION Non-specialised rotations that consider PC competencies as core aspects of being a doctor can be effective to develop SEPC and decrease TS levels.
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Affiliation(s)
- Guilherme Gryschek
- Internal Medicine, University of Campinas School of Medical Sciences, Campinas, SP, Brazil
| | - Dario Cecilio-Fernandes
- Department of Medical Psychology and Psychiatry, University of Campinas School of Medical Sciences, Campinas, SP, Brazil
| | - Guilherme Antonio Moreira de Barros
- Department of Anesthesiology, Universidade Estadual Paulista Júlio de Mesquita Filho Câmpus de Botucatu Faculdade de Medicina, Botucatu, SP, Brazil
| | - Stephen Mason
- Palliative Care Institute Liverpool, University of Liverpool, Liverpool, UK
| | - Marco Antonio de Carvalho-Filho
- CEDAR-Center for Educational Development and Research in Health Sciences, University Medical Centre Groningen, Groningen, Netherlands
- Life and Health Sciences Research Institute, University of Minho, Braga, Portugal
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12
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Shu Z, Wang Y, Li T, Jing L, Sun X. Instrument development of health providers' Knowledge, Attitude and Practice of Hospice Care Scale in China. Int J Health Plann Manage 2020; 36:364-380. [PMID: 33063349 DOI: 10.1002/hpm.3074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 07/25/2020] [Accepted: 09/02/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To match the reform of hospice development in China, this study aimed to construct an indigenized health providers' Knowledge, Attitude and Practice of Hospice Care (KAPHC) Scale in China with good validity and reliability. METHODS We used three steps to develop the scale, establishing items-pool firstly based on literature review and expert consultation, followed by forming a draft-scale design through synthetically consideration, and finally modifying the draft by conducting a self-administrative survey in sampled institution and testing the reliability and validity by statistical analysis. RESULTS The KAPHC Scale was comprised of 15 knowledge items, 24 attitude items and 22 practice items. In the part of knowledge, the Cronbach's α coefficient was 0.686, the average difficulty was 0.62 and average discrimination was 0.46. The attitude items were divided into four domains (KMO = 0.770), with Cronbach's α coefficient of 0.868. The practice items included confidence of practices and self-reported behaviors (KMO = 0.732), with Cronbach's α coefficient of 0.958. CONCLUSION The KAPHC Scale demonstrated good validity and reliability. As an effective tool, the scale may contribute to assessing health providers' KAP status of hospice care and exploring their future education needs in mainland China.
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Affiliation(s)
- Zhiqun Shu
- Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Jiaotong University School of Medicine, Shanghai Ninth People's Hospital, Shanghai, China
| | - Yiting Wang
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Tiantian Li
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Clinic Medical College, Anhui Medical University, Anhui, China
| | - Limei Jing
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaoming Sun
- Zhongshan Hospital, Fudan University, Shanghai, China.,School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Pudong Institution for Health Development, Shanghai, China
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Mason SR, Ling J, Stanciulescu L, Payne C, Paal P, Albu S, Noguera A, Boeriu E, Poroch V, Elsner F, Mosoiu D. From European Association for Palliative Care Recommendations to a Blended, Standardized, Free-to-Access Undergraduate Curriculum in Palliative Medicine: The EDUPALL Project. J Palliat Med 2020; 23:1571-1585. [PMID: 32692279 DOI: 10.1089/jpm.2020.0119] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The World Health Organization recommends that "palliative care should be integrated as a routine element of all Undergraduate Medical Education." However, the provision of training for medical undergraduates is variable; only 18% of 51 European countries have mandatory training in palliative medicine. EDUPALL is an ERASMUS+ funded international collaborative project to develop and pilot an undergraduate program for training in palliative medicine. The objective of this study was to critically review and revise current European Association for Palliative Care (EAPC) Recommendations for the Development of Undergraduate Curricula in Palliative Medicine and translating these into an updated curriculum document. Clinicians, academics, and researchers from Romania, Ireland, Germany, Austria, Spain, and the United Kingdom reviewed the EAPC recommendations using a variant of consensus methodology, Nominal Group Technique. From the updated document, four working-groups translated each recommendation into a specific learning objective, and developed associated learning outcomes, stratified by domain: attitude, cognition, and skills. The outcomes and objectives were organized into discrete teaching units and transferred into a curriculum template, identifying notional hours, teaching, and assessment strategies. To ensure quality control, the draft template was circulated to experts from 17 European countries, together with a brief survey instrument, for peer review purposes. All 17 reviewers returned overwhelmingly positive comments. There was large agreement that: the teaching units were logically organized; learning outcomes covered core training needs; learning objectives provided guidance for teaching sessions; learning modalities were appropriately aligned; and assessment strategies were fit for purpose. An updated and standardized curriculum was developed, which provides a platform for the sequential development of the next phases of the EDUPALL project.
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Affiliation(s)
- Stephen R Mason
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - Julie Ling
- European Association for Palliative Care, Vilvoorde, Belgium
| | | | - Cathy Payne
- All Ireland Institute of Hospice and Palliative Care, Dublin, Ireland
| | - Piret Paal
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Sorin Albu
- Universitatea de Medicina si Farmacie din Targu Mures, Targu Mures, Romania
| | - Antonio Noguera
- Medicina Paliativa, Clínica Universidad de Navarra, Pamplona, Spain
| | - Estera Boeriu
- Universitatea de Medicina si Farmacie Victor Babes din Timisoara, Timisoara, Romania
| | - Vladimir Poroch
- Universitatea de Medicina si Farmacie Gr T Popa Iasi, Iasi, Romania
| | - Frank Elsner
- Palliative Medicine, RWTH Aachen University, Aachen, Germany
| | - Daniela Mosoiu
- Medical School, Transilvania University of Brasov, Brasov, Romania
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A National, Palliative Care Competency Framework for Undergraduate Medical Curricula. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072396. [PMID: 32244658 PMCID: PMC7177526 DOI: 10.3390/ijerph17072396] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/27/2020] [Accepted: 03/30/2020] [Indexed: 11/17/2022]
Abstract
As nearly all doctors deal with patients requiring palliative care, it is imperative that palliative care education starts early. This study aimed to validate a national, palliative care competency framework for undergraduate medical curricula. We conducted a Delphi study with five groups of stakeholders (palliative care experts, physicians, nurses, curriculum coordinators, and junior doctors), inviting them to rate a competency list. The list was organized around six key competencies. For each competency, participants indicated the level to which students should have mastered the skill at the end of undergraduate training. Stability was reached after two rating rounds (N = 82 round 1, N = 54 round 2). The results showed high levels of agreement within and between stakeholder groups. Participants agreed that theoretical knowledge is not enough: Students must practice palliative care competencies, albeit to varying degrees. Overall, communication and personal development and well-being scored the highest: Junior doctors should be able to perform these in the workplace under close supervision. Advance care planning scored the lowest, indicating performance in a simulated setting. A wide range of stakeholders validated a palliative care competency framework for undergraduate medical curricula. This framework can be used to guide teaching about palliative care.
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Wong KY, Li WTV, Yiu PY, Tong TK, Ching OH, Leung LY, Cheung TY, Chan SC, Law HY, Cheng CH. New Directions in Pediatric Palliative Care Education for Preclinical Medical and Nursing Students. MEDICAL SCIENCE EDUCATOR 2020; 30:445-455. [PMID: 34457688 PMCID: PMC8368940 DOI: 10.1007/s40670-020-00928-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Since insufficient education has partially contributed to challenges in providing pediatric palliative care (PPC), a cross-sectional questionnaire study was conducted to explore the knowledge, attitudes, and educational needs of preclinical medical and nursing students in Hong Kong. METHODS Pretested self-administered 44-item questionnaires with written informed consent were distributed to 241 medical and nursing students at Li Ka Shing Faculty of Medicine, the University of Hong Kong, between February and March 2019. This questionnaire covered eleven categories related to participants' knowledge of and attitudes towards PPC. A convenience sampling method was used. Data analysis was performed with descriptive statistics, chi-squared, and Fisher's exact test. RESULTS Only 38.3% of participants had heard of PPC before, but 73.5% advocated for its local commencement. A large number, with more in nursing, misunderstood fundamental palliative concepts and pain assessment methods. Many reported that undergraduate curricula should include PPC since they were not prepared to deal and cope with dying children. More medical students identified multidisciplinary approaches in PPC while less believed that they were mentally prepared to discuss death and dying. The majority indicated family as the final decision maker, even for teenage patients. Although a large proportion agreed that PPC should be delivered at home since the diagnosis of a life-limiting illness, only a few were aware of the suggested referral structure. CONCLUSIONS Most healthcare students were supportive of PPC despite their limited exposure. PPC education on palliative principles, pain management, multidisciplinary approaches, and emotional coping skills is needed and welcomed among students.
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Affiliation(s)
- Kan Yin Wong
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Wai Tak Victor Li
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Pui Yu Yiu
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Tsz Kiu Tong
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - On Hang Ching
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Lok Yin Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Tsz Yau Cheung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Sze Chai Chan
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Hoi Ying Law
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Cheuk Hei Cheng
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
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Boland JW, Barclay S, Gibbins J. Twelve tips for developing palliative care teaching in an undergraduate curriculum for medical students. MEDICAL TEACHER 2019; 41:1359-1365. [PMID: 30689479 DOI: 10.1080/0142159x.2018.1533243] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Palliative care is the holistic care of patients with advanced, progressive incurable illness. Palliative care is well recognized as an essential component of medical student curricula. However, teaching is variable within medical schools. Using current literature, these tips aim to highlight key points necessary to facilitate the development and delivery of palliative care teaching to medical students. The key practice points include: clinical exposure to patients with palliative care needs and those that are dying, being compulsory (and integrated) across the course, summative and formative assessments to encourage learning, support from within the university for curricular time and development, visits to a hospice/inpatient palliative care facility, emphasis on clinically based learning later in the course, teaching by specialists in palliative care as well as specialists in other areas including Family Doctors/General Practitioners, innovative teaching methods and inter-professional learning to develop teaching.
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Affiliation(s)
- Jason W Boland
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Stephen Barclay
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jane Gibbins
- St Julia's Hospice, Cornwall Hospice Care, Hayle, UK
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Pieters J, Dolmans DHJM, Verstegen DML, Warmenhoven FC, Courtens AM, van den Beuken-van Everdingen MHJ. Palliative care education in the undergraduate medical curricula: students' views on the importance of, their confidence in, and knowledge of palliative care. BMC Palliat Care 2019; 18:72. [PMID: 31455326 PMCID: PMC6712798 DOI: 10.1186/s12904-019-0458-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 08/15/2019] [Indexed: 11/24/2022] Open
Abstract
Background The need for palliative care is increasing. Since almost every junior doctor will come across palliative care patients, it is important to include palliative care in the undergraduate curriculum. The objective of this research is to gather undergraduate students’ views on palliative care in terms of its importance, their confidence in and knowledge of the domain. Methods Final-year medical students at four Dutch medical faculties were surveyed. The questionnaire measured their views on the education they had received, their self-reported confidence in dealing with palliative care patients and their knowledge of palliative care. Results Two hundred twenty-two medical students participated in this study. Students considered palliative care education relevant, especially training in patient-oriented care and communication with the patient. Students felt that several topics were inadequately covered in the curriculum. Overall, the students did not feel confident in providing palliative care (59.6%), especially in dealing with the spiritual aspect of palliative care (77%). The knowledge test shows that only 48% of the students answered more than half of the questions correctly. Conclusion The students in this study are nearly junior doctors who will soon have to care for palliative patients. Although they think that palliative care is important, in their opinion the curriculum did not cover many important aspects, a perception that is also in line with their lack of confidence and knowledge in this domain. Therefore, it is important to improve palliative care education in the medical curriculum.
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Affiliation(s)
- Jolien Pieters
- Department of Educational Development and Research Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 60, 6229, ER, Maastricht, The Netherlands.
| | - Diana H J M Dolmans
- Department of Educational Development and Research Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 60, 6229, ER, Maastricht, The Netherlands
| | - Daniëlle M L Verstegen
- Department of Educational Development and Research Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 60, 6229, ER, Maastricht, The Netherlands
| | - Franca C Warmenhoven
- Department of Educational Development and Research Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 60, 6229, ER, Maastricht, The Netherlands
| | - Annemie M Courtens
- Centre of Expertise for Palliative Care, Maastricht UMC+, Maastricht, The Netherlands
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Diver R, Quince T, Barclay S, Benson J, Brimicombe J, Wood D, Thiemann P. Palliative care in medical practice: medical students' expectations. BMJ Support Palliat Care 2018; 8:285-288. [PMID: 29622688 DOI: 10.1136/bmjspcare-2017-001486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/18/2018] [Accepted: 03/21/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVES During their careers, all doctors will be involved in the care of the dying, and this is likely to increase with current demographic trends. Future doctors need to be well-prepared for this. Little is known about medical students' expectations about providing palliative care. Our aim was to investigate how satisfying students expect palliative care to be, and any attitudes towards palliative care associated with a negative expectation. METHODS Fifteen UK medical schools participated in the study, with 1898 first and final year students completing an online questionnaire which investigated how satisfying they expect providing palliative care to be and their attitudes towards palliative care. RESULTS At both the beginning and end of their training, a significant proportion of students expect palliative care to be less satisfying than other care (19.3% first year, 16% final year). Students expecting palliative care to be less satisfying were more likely to be men, and their attitudes suggest that while they understand the importance of providing palliative care they are concerned about the potential impact of this kind of work on them personally. CONCLUSIONS Medical student education needs to address why palliative care is important and how to deliver it effectively, and the strategies for dealing positively with the impact of this work on future clinicians.
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Affiliation(s)
- Ruth Diver
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Thelma Quince
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephen Barclay
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - John Benson
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - James Brimicombe
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Diana Wood
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Pia Thiemann
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Arai K, Saiki T, Imafuku R, Kawakami C, Fujisaki K, Suzuki Y. What do Japanese residents learn from treating dying patients? The implications for training in end-of-life care. BMC MEDICAL EDUCATION 2017; 17:205. [PMID: 29132340 PMCID: PMC5683338 DOI: 10.1186/s12909-017-1029-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 10/31/2017] [Indexed: 05/17/2023]
Abstract
BACKGROUND How medical residents' experiences with care for dying patients affect their emotional well-being, their learning outcomes, and the formation of their professional identities is not fully understood. We examine residents' emotional states and learning occurring during the provision of care to dying patients and specifically discuss the impact of providing end-of-life (EOL) care on professional identity formation. METHODS Semi-structured interviews were conducted with 13 residents who had graduated in the last 3 to 5 years. Thematic theoretical analysis was applied, and key themes were developed based on Kolb's experiential learning cycle. RESULTS Eight key themes emerged from the analysis. The residents experienced dilemmas in confronting the reality of medical uncertainty as well as a disruption of emotional state and self-efficacy. Although the residents felt a sense of helplessness and guilt, they were able to reflect on strategies for handling medical care that focused on patients and that required a truly sincere attitude. They also contemplated the importance of palliative care and communication with patients, patients' family members and medical staff. Building on these experiences, the residents rebuilt a sense of awareness that allowed them to directly engage with the type of medical care that they are likely to be called upon to perform in the future as the population continues to age. CONCLUSIONS This study revealed Japanese residents' perceptions, emotions and learning processes in caring for dying patients by applying Kolb's experiential learning theory. The findings of this study may illuminate valuable pieces of knowledge for future education in EOL care.
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Affiliation(s)
- Kazuko Arai
- Medical Education Development Center, Gifu University, 1-1 Yanagido, Gifu, 501-1194 Japan
- Nagasaki Public Health Center, 3-6-24 Nagasaki, Totshima City, Tokyo 171-0051 Japan
| | - Takuya Saiki
- Medical Education Development Center, Gifu University, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Rintaro Imafuku
- Medical Education Development Center, Gifu University, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Chihiro Kawakami
- Medical Education Development Center, Gifu University, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Kazuhiko Fujisaki
- Medical Education Development Center, Gifu University, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Yasuyuki Suzuki
- Medical Education Development Center, Gifu University, 1-1 Yanagido, Gifu, 501-1194 Japan
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The contribution of undergraduate palliative care education: does it influence the clinical patient's care? Curr Opin Support Palliat Care 2016; 9:375-91. [PMID: 26418527 DOI: 10.1097/spc.0000000000000169] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The aim of this 2-year systematic review is to understand how learner assessment and curriculum evaluation of education in palliative care is being undertaken and to examine whether current undergraduate education influences the clinical patient's care. RECENT FINDINGS Almost half of the 30 studies reviewed used a qualitative approach to evaluate learning experiences. Only three of them were controlled studies and a further one was a cohort study.When students openly express themselves, they agree that there is 'something' deep as regards the core or the essence of medical practice or nursing. They feel that they become better professionals and better prepared for the patients, not only in terms of end of life care, but also as regards care, irrespective of the phase of the disease.The inclusion of palliative care in undergraduate education is a way of providing knowledge, skill, and competences about palliative care (especially communication) and also improving attitudes toward caring in advanced disease and at the end of life. Different methods of experiential learning, even brief experiences, which bring students into close contact with palliative care clinical cases or patients, are providing better results. SUMMARY From research studies, there is only indirect evidence that palliative care training at university leads to better clinical care of patients. In the future, long-term cohort or controlled studies might answer that question.
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Boland JW, Dikomitis L, Gadoud A. Medical students writing on death, dying and palliative care: a qualitative analysis of reflective essays. BMJ Support Palliat Care 2016; 6:486-492. [DOI: 10.1136/bmjspcare-2016-001110] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 06/01/2016] [Accepted: 07/14/2016] [Indexed: 01/12/2023]
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Wood DF. Mens sana in corpore sano: student well-being and the development of resilience. MEDICAL EDUCATION 2016; 50:20-3. [PMID: 26695463 PMCID: PMC5064634 DOI: 10.1111/medu.12934] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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If you want to understand the invisible, look carefully at the visible. Curr Opin Support Palliat Care 2015; 9:355-6. [PMID: 26418528 DOI: 10.1097/spc.0000000000000175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Thiemann P, Quince T, Benson J, Wood D, Barclay S. Medical Students' Death Anxiety: Severity and Association With Psychological Health and Attitudes Toward Palliative Care. J Pain Symptom Manage 2015; 50:335-342.e2. [PMID: 25979362 DOI: 10.1016/j.jpainsymman.2015.03.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 03/14/2015] [Accepted: 04/01/2015] [Indexed: 11/25/2022]
Abstract
CONTEXT Death anxiety (DA) is related to awareness of the reality of dying and death and can be negatively related to a person's psychological health. Physicians' DA also may influence their care for patients approaching death. Doctors face death in a professional context for the first time at medical school, but knowledge about DA among medical students is limited. OBJECTIVES This study examined medical students' DA in relation to: 1) its severity, gender differences, and trajectory during medical education and 2) its associations with students' attitudes toward palliative care and their psychological health. METHODS Four cohorts of core science and four cohorts of clinical students at the University of Cambridge Medical School took part in a questionnaire survey with longitudinal follow-up. Students who provided data on the revised Collett-Lester Fear of Death Scale were included in the analysis (n = 790). RESULTS Medical students' DA was moderate, with no gender differences and remained very stable over time. High DA was associated with higher depression and anxiety levels and greater concerns about the personal impact of providing palliative care. CONCLUSION The associations between high DA and lower psychological health and negative attitudes toward palliative care are concerning. It is important to address DA during medical education to enhance student's psychological health and the quality of their future palliative care provision.
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Affiliation(s)
- Pia Thiemann
- Primary Care Unit, University of Cambridge, Cambridge, United Kingdom; School of Clinical Medicine, Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom.
| | - Thelma Quince
- Primary Care Unit, University of Cambridge, Cambridge, United Kingdom; School of Clinical Medicine, Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - John Benson
- Primary Care Unit, University of Cambridge, Cambridge, United Kingdom; School of Clinical Medicine, Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Diana Wood
- Primary Care Unit, University of Cambridge, Cambridge, United Kingdom; School of Clinical Medicine, Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Stephen Barclay
- Primary Care Unit, University of Cambridge, Cambridge, United Kingdom; School of Clinical Medicine, Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
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