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Dronia MC, Dillen K, Elsner F, Schallenburger M, Neukirchen M, Hagemeier A, Hamacher S, Doll A, Voltz R, Golla H. Palliative care education and knowledge transfer into practice - a multicenter survey among medical students and resident physicians in Germany using a mixed-methods design. GMS JOURNAL FOR MEDICAL EDUCATION 2024; 41:Doc27. [PMID: 39131897 PMCID: PMC11310786 DOI: 10.3205/zma001682] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 01/30/2024] [Accepted: 02/20/2024] [Indexed: 08/13/2024]
Abstract
Objective In 2009, Palliative care was incorporated into the medical curriculum as Cross-Sectional Subject 13 (QB13) by means of the revision of the Medical Licensing Regulations for Physicians. The aim of this study was to determine the strengths and deficits of QB13 student education for palliative care in clinical practice in a multi-centre setting and to identify potential for improvement. Methods Online questionnaires filled out by medical students during their Practical Year (PY) and resident physicians from the university hospitals in Aachen, Düsseldorf, and Cologne were descriptively analyzed using SPSS; free-text responses were categorized and quantified. Semi-structured interviews with the resident physicians (using a mixed-methods design) were analyzed through content analysis. Emerging categories were quantified. Results Analysis of 130 fully completed questionnaires and 23 interviews revealed that participants particularly benefited from patient- and practice-oriented small-group sessions for their clinical work. Despite some university-specific differences, the PY students identified a need for training in end-of-life-care, while resident physicians saw a need for training primarily in dealing with patients and their relatives. They also reported deficits in transferability. Conclusion QB13 should be organised in cross-university curricula and provide sufficient resources for practical-oriented small-group teaching. Based on the "unit of care", besides caring for palliative patients, dealing with patients' families should also be an education focus. To improve transferability into clinical practice, students should be actively involved in the care of palliative patients.
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Affiliation(s)
- Marie-Christin Dronia
- University of Cologne, Faculty of Medicine, Cologne, Germany
- University Hospital, Centre for Palliative Medicine, Cologne, Germany
| | - Kim Dillen
- University of Cologne, Faculty of Medicine, Cologne, Germany
- University Hospital, Centre for Palliative Medicine, Cologne, Germany
| | - Frank Elsner
- RWTH Aachen University, Medical Faculty, Clinic for Palliative Medicine, Aachen, Germany
| | - Manuela Schallenburger
- Heinrich-Heine University Düsseldorf, Medical Faculty, Interdisciplinary Centre for Palliative Medicine, Düsseldorf, Germany
- University Hospital Düsseldorf, Centre for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Düsseldorf, Germany
| | - Martin Neukirchen
- Heinrich-Heine University Düsseldorf, Medical Faculty, Interdisciplinary Centre for Palliative Medicine, Düsseldorf, Germany
- University Hospital Düsseldorf, Centre for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Düsseldorf, Germany
- Heinrich-Heine University Düsseldorf, Medical Faculty and University Hospital Düsseldorf, Department of Anaesthesiology, Düsseldorf, Germany
| | - Anna Hagemeier
- University of Cologne, Faculty of Medicine, Cologne, Germany
- University Hospital Cologne, Institute for Medical Statistics and Bioinformatics, Cologne, Germany
| | - Stefanie Hamacher
- University of Cologne, Faculty of Medicine, Cologne, Germany
- University Hospital Cologne, Institute for Medical Statistics and Bioinformatics, Cologne, Germany
| | - Axel Doll
- University Hospital, Centre for Palliative Medicine, Cologne, Germany
| | - Raymond Voltz
- University of Cologne, Faculty of Medicine, Cologne, Germany
- University Hospital, Centre for Palliative Medicine, Cologne, Germany
- University Hospital, Centre for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Cologne, Germany
- University Hospital, Centre for Health Services Research Cologne (ZVFK), Cologne, Germany
| | - Heidrun Golla
- University Hospital, Centre for Palliative Medicine, Cologne, Germany
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Dunger C, Higginson IJ, Gysels M, Booth S, Simon ST, Bausewein C. Breathlessness and crises in the context of advanced illness: A comparison between COPD and lung cancer patients. Palliat Support Care 2015; 13:229-37. [PMID: 24524686 DOI: 10.1017/s147895151300120x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The objective of this study was to explore and contrast the experience and meaning of breathlessness in patients with chronic obstructive pulmonary disease (COPD) or lung cancer at the end of life. METHOD We conducted a qualitative study embedded in a longitudinal study using topic-guided in-depth interviews with a purposive sample of patients suffering from breathlessness affecting their daily activities due to advanced (primary or secondary) lung cancer or COPD stage III/IV. All interviews were audiotaped, transcribed verbatim, and analyzed using framework analysis. RESULTS Ten COPD and eight lung cancer patients were interviewed. Both groups reported similarities in their experience. These included exertion through breathlessness throughout the illness course, losses in their daily activities, and the experience of breathlessness leading to crises. The main difference was the way in which patients adapted to their particular illness experience and the resulting crises over time. While COPD patients more likely sought to get their life with breathlessness under control, speaking of daily living with breathlessness under certain conditions, the participating lung cancer patients often faced the possibility of death and expressed a need for security. SIGNIFICANCE OF RESULTS Breathlessness leads to crises in patients with advanced disease. Although experiences of patients are similar, reactions and coping mechanisms vary and are more related to the disease and the stage of disease.
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Affiliation(s)
- Christine Dunger
- Institute of Ethics and Communication in Health Care, University of Witten/Herdecke,58453 Witten,Germany
| | - Irene J Higginson
- King's College London, Department of Palliative Care, Policy and Rehabilitation,Cicely Saunders Institute,London SE5 9PJ,United Kingdom
| | - Marjolein Gysels
- Amsterdam Institute of Social Science Research,Amsterdam,The Netherlands
| | - Sara Booth
- Palliative Care Team,Addenbrooke's Hospital,Cambridge CB2 0QQ,United Kingdom
| | - Steffen T Simon
- King's College London, Department of Palliative Care, Policy and Rehabilitation,Cicely Saunders Institute,London SE5 9PJ,United Kingdom
| | - Claudia Bausewein
- King's College London, Department of Palliative Care, Policy and Rehabilitation,Cicely Saunders Institute,London SE5 9PJ,United Kingdom
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