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Kopp ML, Mayberry ALM. An End-of-Life Communication Performance Rubric: Reliability Assessment. J Hosp Palliat Nurs 2021; 23:429-434. [PMID: 34050097 DOI: 10.1097/njh.0000000000000772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Nurse educators still struggle with teaching and assessing end-of-life communication skills. Many resources are available to assist in teaching end-of-life communication, but few tools exist to assess performance learning outcomes. Behavior evaluation tools must be user-friendly and provide beneficial student feedback. Quality end-of-life patient care and nursing job satisfaction depend on skillful communication. The purpose of this study was to evaluate the reliability of an end-of-life communication clinical simulation evaluation performance rubric. Moderate interrater consistency and agreement were found between 3 evaluators when assessing the same students. All simulation evaluators agreed that the performance rubric was user-friendly and provided rich feedback for students during simulation debriefing. The performance evaluation tool was moderately effective when evaluating end-of-life communication performance and appears as a worthy framework for other behavior evaluations.
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El-Jawahri A, Forst D, Fenech A, Brenner KO, Jankowski AL, Waldman L, Sereno I, Nipp R, Greer JA, Traeger L, Jackson V, Temel J. Relationship Between Perceptions of Treatment Goals and Psychological Distress in Patients With Advanced Cancer. J Natl Compr Canc Netw 2020; 18:849-855. [PMID: 32634779 DOI: 10.6004/jnccn.2019.7525] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 12/16/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Studies have shown gaps in prognostic understanding among patients with cancer. However, few studies have explored patients' perceptions of their treatment goals versus how they perceive their oncologist's goals, and the association of these views with their psychological distress. METHODS We conducted a cross-sectional study of 559 patients with incurable lung, gastrointestinal, breast, and brain cancers. The Prognosis and Treatment Perception Questionnaire was used to assess patients' reports of their treatment goal and their oncologist's treatment goal, and the Hospital Anxiety and Depression Scale was used to assess patients' psychological symptoms. RESULTS We found that 61.7% of patients reported that both their treatment goal and their oncologist's treatment goal were noncurative, whereas 19.3% reported that both their goal and their oncologist's goal were to cure their cancer, 13.9% reported that their goal was to cure their cancer whereas their oncologist's goal was noncurative, and 5% reported that their goal was noncurative whereas their oncologist's goal was curative. Patients who reported both their goal and their oncologist's goal as noncurative had higher levels of depression (B=0.99; P=.021) and anxiety symptoms (B=1.01; P=.015) compared with those who reported that both their goal and their oncologist's goal was curative. Patients with discordant perceptions of their goal and their oncologist's goal reported higher anxiety symptoms (B=1.47; P=.004) compared with those who reported that both their goal and their oncologist's goal were curative. CONCLUSIONS One-fifth of patients with incurable cancer reported that both their treatment goal and their oncologist's goal were to cure their cancer. Patients who acknowledged the noncurative intent of their treatment and those who perceived that their treatment goal was discordant from that of their oncologist reported greater psychological distress.
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Affiliation(s)
- Areej El-Jawahri
- 1Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center.,2Harvard Medical School, and
| | - Deborah Forst
- 1Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center.,2Harvard Medical School, and
| | - Alyssa Fenech
- 1Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center.,2Harvard Medical School, and
| | - Keri O Brenner
- 2Harvard Medical School, and.,3Department of Medicine, Division of Palliative Care, Massachusetts General Hospital, Boston, Massachusetts; and.,4Department of Medicine, Section of Palliative Care, Stanford University, Stanford, California
| | - Amanda L Jankowski
- 1Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center.,2Harvard Medical School, and
| | - Lauren Waldman
- 1Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center.,2Harvard Medical School, and
| | - Isabella Sereno
- 1Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center.,2Harvard Medical School, and
| | - Ryan Nipp
- 1Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center.,2Harvard Medical School, and
| | - Joseph A Greer
- 1Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center.,2Harvard Medical School, and
| | - Lara Traeger
- 1Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center.,2Harvard Medical School, and
| | - Vicki Jackson
- 2Harvard Medical School, and.,3Department of Medicine, Division of Palliative Care, Massachusetts General Hospital, Boston, Massachusetts; and
| | - Jennifer Temel
- 1Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center.,2Harvard Medical School, and
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Selecting and Performing Service-Learning in a Team-Based Learning Format Fosters Dissonance, Reflective Capacity, Self-Examination, Bias Mitigation, and Compassionate Behavior in Prospective Medical Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16203926. [PMID: 31623072 PMCID: PMC6843913 DOI: 10.3390/ijerph16203926] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 10/13/2019] [Accepted: 10/14/2019] [Indexed: 11/17/2022]
Abstract
More compassionate behavior should make both patients and their providers happier and healthier. Consequently, work to increase this behavior ought to be a major component of premedical and medical education. Interactions between doctors and patients are often less than fully compassionate owing to implicit biases against patients. Such biases adversely affect treatment, adherence, and health outcomes. For these reasons, we studied whether selecting and performing service-learning projects by teams of prospective medical students prompts them to write reflections exhibiting dissonance, self-examination, bias mitigation, dissonance reconciliation, and compassionate behavior. Not only did these students report changes in their behavior to become more compassionate, but their reflective capacity also grew in association with selecting and performing team service-learning projects. Components of reflective capacity, such as reflection-on-action and self-appraisal, correlated strongly with cognitive empathy (a component of compassion) in these students. Our results are, however, difficult to generalize to other universities and other preprofessional and professional healthcare programs. Hence, we encourage others to test further our hypothesis that provocative experiences foster frequent self-examination and more compassionate behavior by preprofessional and professional healthcare students, especially when teams of students are free to make their own meaning of, and build trust and psychological safety in, shared experiences.
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