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Pieters J, Verstegen D, Dolmans D, Neis E, Warmenhoven F, van den Beuken-van Everdingen M. Spiritual dimension in palliative medicine: a qualitative study of learning tasks: medical students, teachers, educationalists. BMJ Support Palliat Care 2023; 13:e408-e414. [PMID: 34285040 PMCID: PMC10715490 DOI: 10.1136/bmjspcare-2021-003026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 06/01/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Palliative care is gaining importance within the physician's range of duties. In the undergraduate medical curriculum, education on the four dimensions of care is insufficient. The spiritual dimension is hardly addressed. Therefore, we developed a coherent set of learning tasks targeted at learning to communicate about the spiritual dimension. The learning tasks are based on educational principles of authentic learning, reflective learning and longitudinal integration in the curriculum. This article reports on the feasibility of using these learning tasks in the medical curricula. METHODS Teachers and educational scientists were interviewed and students were asked to evaluate the learning tasks in focus groups. Interview transcripts were analysed by three independent researchers. RESULTS The learning tasks encourage the students to reflect on the four dimensions of palliative care and their personal values. Learning was clearly organised around authentic learning tasks relevant to the later profession, using paper, video cases, as well as simulations and real patients. Participants suggest giving more attention to cultural diversity. As palliative care is an emotionally charged subject, the safety of both student and patient should be guaranteed. All participants indicated that the program should start in the bachelor phase and most agreed that it should be integrated vertically and horizontally throughout the undergraduate program, although there is some debate about the optimal moment to start. CONCLUSION The tasks, are authentic, encourage the students to reflect on the spiritual dimension of palliative care and are suitable for integration in the undergraduate medical curriculum.
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Affiliation(s)
- Jolien Pieters
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Daniëlle Verstegen
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Diana Dolmans
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Evelien Neis
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Franca Warmenhoven
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
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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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Physicians' and Nurses' Knowledge in Palliative Care: Multidimensional Regression Models. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18095031. [PMID: 34068622 PMCID: PMC8126108 DOI: 10.3390/ijerph18095031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 11/17/2022]
Abstract
The increase in life expectancy has led to a growth in the number of people in need of palliative care. Health professionals must possess appropriate knowledge and skills. This study aimed to assess knowledge in palliative care through the Palliative Care Knowledge Test Spanish Version (PCKT-SV)®. A cross-sectional analytical study was conducted in 40 primary care health services. A total of 600 PCKT-SV questionnaires were distributed among health professionals; 561 of them (226 nurses and 335 physicians) were properly filled up. Sociodemographic information, education, and work experience were also recorded. A total of 34.41% of the nurses and 67.40% of the physicians showed good or excellent knowledge of palliative care. Physicians' scores for pain, dyspnea, and psychiatric disorders were higher than those of the nurses. Nurses scored significantly better in philosophy. Professionals with continuous training in palliative care showed a higher level of knowledge. Age and work experience of physicians and undergraduate training in nurses had significant weight in knowledge. Developing continuous training and enhancing undergraduate training in palliative care will lead to improved patient care at the end of life.
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Levy K, Grant PC, Kerr CW, Byrwa DJ, Depner RM. Hospice Patient Care Goals and Medical Students' Perceptions: Evidence of a Generation Gap? Am J Hosp Palliat Care 2020; 38:114-122. [PMID: 32588649 DOI: 10.1177/1049909120934737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The ability to perceive care goals of the dying may be an indicator of future quality patient-centered care. Research conducted on end-of-life goals indicates discrepancies between patients and physicians. OBJECTIVE The aim of this study is to compare end-of-life care goals of hospice patients and medical student perceptions of patient care goals. DESIGN Hospice patients and medical students were surveyed on their care goals and perceptions, respectively, using an 11-item survey of goals previously identified in palliative care literature. Medical student empathy was measured using the Interpersonal Reactivity Index. SETTINGS/PARTICIPANTS Eighty hospice patients and 176 medical students (97 first-year and 79 third-year) in a New York State medical school. RESULTS Medical students ranked 7 of the 11 care goals differently than hospice patients: not being a burden to family (p < .001), time with family and friends (p = .002), being at peace with God (p < .001), dying at home (p = .004), feeling that life was meaningful (p < .001), living as long as possible (p < .001), and resolving conflicts (p < .001). Third-year students were less successful than first-year students in perceiving patient care goals of hospice patients. No significant differences in medical student empathy were found based on student year. CONCLUSIONS Medical students, while empathetic, were generally unsuccessful in perceiving end-of-life care goals of hospice patients in the psychosocial and spiritual domains. Differences impeding the ability of medical students to understand these care goals may be generationally based. Increased age awareness and sensitivity may improve future end-of-life care discussions. Overall, there is a need to recognize the greater dimensionality of the dying in order to provide the most complete patient-centered care.
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Affiliation(s)
- Kathryn Levy
- Hospice & Palliative Care Buffalo, Cheektowaga, NY, USA.,Department of Planning and Research, Trocaire College, Buffalo, NY, USA
| | - Pei C Grant
- Hospice & Palliative Care Buffalo, Cheektowaga, NY, USA
| | | | - David J Byrwa
- Hospice & Palliative Care Buffalo, Cheektowaga, NY, USA.,School of Medicine, 12292University at Buffalo, the State University of New York, Buffalo, NY, USA
| | - Rachel M Depner
- Hospice & Palliative Care Buffalo, Cheektowaga, NY, USA.,Department of Counseling, School and Educational Psychology, 12292University at Buffalo, the State University of New York, Buffalo, NY, USA
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Melgaard SK, Neergaard MA. Medical students do not feel confident in managing palliative care as future doctors. PROGRESS IN PALLIATIVE CARE 2019. [DOI: 10.1080/09699260.2019.1696007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- S. K. Melgaard
- Oncology Department, Aarhus University Hospital, Aarhus, Denmark
| | - M. A. Neergaard
- Oncology Department, Aarhus University Hospital, Aarhus, Denmark
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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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Alminoja A, Piili RP, Hinkka H, Metsänoja R, Hirvonen O, Tyynelä-Korhonen K, Kaleva-Kerola J, Saarto T, Kellokumpu-Lehtinen PLI, Lehto JT. Does Decision-making in End-of-life Care Differ Between Graduating Medical Students and Experienced Physicians? In Vivo 2019; 33:903-909. [PMID: 31028215 PMCID: PMC6559926 DOI: 10.21873/invivo.11557] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/11/2019] [Accepted: 04/12/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Appropriate decision-making in end-of-life (EOL) care is essential for both junior and senior physicians. The aim of this study was to compare the decision-making and attitudes of medical students with those of experienced general practitioners (GP) regarding EOL-care. MATERIALS AND METHODS A questionnaire presenting three cancer patient scenarios concerning decisions and ethical aspects of EOL-care was offered to 500 Finnish GPs and 639 graduating medical students in 2015-2016. RESULTS Responses were received from 222 (47%) GPs and 402 (63%) students. The GPs withdrew antibiotics (p<0.001) and nasogastric tubes (p=0.007) and withheld resuscitation (p<0.001), blood transfusions (p=0.002) and pleural drainage (p<0.001) more often than did the students. The students considered euthanasia and assisted suicide less reprehensible (p<0.001 in both) than did the GPs. CONCLUSION Medical students were more unwilling to withhold and withdraw therapies in EOL-care than were the GPs, but the students considered euthanasia less reprehensible. Medical education should include aspects of decision-making in EOL-care.
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Affiliation(s)
- Aleksi Alminoja
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Reetta P Piili
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Oncology, Tampere University Hospital, Tampere, Finland
| | - Heikki Hinkka
- Rehabilitation Center Apila (ret.), Kangasala, Finland
| | - Riina Metsänoja
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Outi Hirvonen
- Department of Oncology and Radiotherapy, Turku University Hospital, and Department of Clinical Oncology, University of Turku, Turku, Finland
| | | | | | - Tiina Saarto
- Helsinki University Hospital, Comprehensive Cancer Center, Department of Palliative Care and Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Pirkko-Liisa I Kellokumpu-Lehtinen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Oncology, Tampere University Hospital, Tampere, Finland
| | - Juho T Lehto
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Oncology, Tampere University Hospital, Tampere, Finland
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Kim DY, Kim KJ, Shin SJ, Heo DS, Lee SN, Nam EM. Factors That Influence Attitudes Toward End-of-Life Care Among Medical Students: Nationwide Survey for Fourth-Year Korean Medical Students. Am J Hosp Palliat Care 2019; 36:460-465. [DOI: 10.1177/1049909118822287] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Positive attitudes for end-of-life (EOL) care along with adequate education are key factors for the provision of quality EOL care. This national study was conducted to identify the factors that influence attitudes toward EOL care on medical students. Method: An anonymous survey was designed and administered to fourth-year medical students at all 41 medical schools in Korea. Topics related to EOL care were assessed in classroom teaching, bedside teaching, and feedback experiences during clinical clerkships. Seven questions for self-rated attitudes and affecting factors were analyzed toward EOL care. Results: With a response rate of 49.2%, the median number of topics recognized by the students as having been delivered was 5 of 11 topics in classroom lectures and 1 of 8 topics in clinical experience. Although few (21.2%) participants indicated that they felt ready for EOL care practice, nevertheless, most felt that they should have adequate knowledge of and preparation for clinical competency in EOL care. Several parameters including respondent’s demographics and exposure to EOL care topics in classroom and in bedside teaching influenced the responses to all 7 attitude questions. However, having more than 1 bedside experience was the only factor positively affecting all attitudinal measures. Conclusions: Clinical experience related to EOL care seems to be the utmost priory in fostering positive attitudes and competency among medical students.
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Affiliation(s)
- Do Yeun Kim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Kyong-Jee Kim
- Department of Medical Education, Dongguk University School of Medicine, Goyang, Republic of Korea
| | - Sung Joon Shin
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Dae Seog Heo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Soon Nam Lee
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Eun Mi Nam
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea
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Storarri ACM, de Castro GD, Castiglioni L, Cury PM. Confidence in palliative care issues by medical students and internal medicine residents. BMJ Support Palliat Care 2017; 9:e1. [PMID: 29248898 DOI: 10.1136/bmjspcare-2017-001341] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 11/14/2017] [Accepted: 11/22/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Palliative care (PC) is a relatively new field in Brazil, but this knowledge is of great importance in medical practice. OBJECTIVE To evaluate the degree of confidence among medical students and first-year and second-year internal medicine residents in addressing issues of death and terminal illness with patients and their families. METHOD A modified version of the Self-Efficacy in Palliative Care Scale was applied to 293 students in their first year to sixth year at the School of Medicine of São José do Rio Preto and to 43 residents in their first year or second year of medical practice at the same institution in Brazil, in 2015. The questionnaire evaluated students' opinions on the need to include theoretical and practical classes on PC in the medical school. RESULTS Students in their fifth year of medical school were more confident than the students in their first, second, third and fourth years; there were no statistically significant differences between fifth-year students, sixth-year students and the internal medicine residents. CONCLUSION Residents were more confident than all of the medical school students except those in their fifth year (P<0.05) because they have more contact with terminally ill patients than other students do; fifth-year medical students are likely overestimating their abilities.
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Affiliation(s)
| | | | - Lilian Castiglioni
- Department of Bioestatistic, Faculdade de Medicina de São José do Rio Preto, Brazil, South America
| | - Patricia Maluf Cury
- FACERES Medical School, Faculdade de medicina de São José do Rio Preto, Brazil, South America
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Khraisat OM, Hamdan M, Ghazzawwi M. Palliative Care Issues and Challenges in Saudi Arabia. J Palliat Care 2017; 32:121-126. [DOI: 10.1177/0825859717743229] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Nurses are the heart of the palliative care team who provide high standards of care since they spend the longest time with patients. However, lack of adequate knowledge of palliative care is considered as one of the main obstacles to palliative care improvement. Aim: A survey was conducted to assess Saudi nursing students’ knowledge about palliative care. Methods: Using a descriptive design, 154 students who enrolled in first year and who will graduate within 1 year were surveyed in a nursing college located in Riyadh, the capital of Saudi Arabia. The Palliative Care Quiz for Nursing (PCQN) was used to assess students’ knowledge. Results: The sample mean age was 22.1 (standard deviation (SD): 2.2), and most of the students were predominately female (93; 60.4%) and the majority were senior students who will be graduated within the current academic year (105; 68.2%). The total mean score of palliative care knowledge was low at 7.30 (SD: 0.56; range: 0-13), and the number of correctly answered statements ranged from 16 (10.4%, statement no. 7) to 91 (59.1%, statement no. 18). Eleven misconceptions about palliative care among participants are conceptually categorized into 3categories: principle and philosophy of palliative care, pain and symptom management, and psychological and spiritual care. Conclusion: Integrating palliative care education within the nursing programs is the backbone to improve nursing students’ knowledge, namely, in principles of palliative care and symptom management.
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Affiliation(s)
| | - Mahmoud Hamdan
- Nursing Department, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia
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Fosse A, Zuidema S, Boersma F, Malterud K, Schaufel MA, Ruths S. Nursing Home Physicians' Assessments of Barriers and Strategies for End-of-Life Care in Norway and The Netherlands. J Am Med Dir Assoc 2017; 18:713-718. [PMID: 28465128 DOI: 10.1016/j.jamda.2017.03.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/11/2017] [Accepted: 03/13/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Working conditions in nursing homes (NHs) may hamper teamwork in providing quality end-of-life (EOL) care, especially the participation of NH physicians. Dutch NH physicians are specialists or trainees in elderly care medicine with NHs as the main workplace, whereas in Norway, family physicians usually work part time in NHs. Thus, we aimed at assessing and comparing NH physicians' perspectives on barriers and strategies for providing EOL care in NHs in Norway and in The Netherlands. DESIGN A cross-sectional study using an electronic questionnaire was conducted in 2015. SETTING AND PARTICIPANTS All NH physicians in Norway (approximately 1200-1300) were invited to participate; 435 participated (response rate approximately 35%). Of the total 1664 members of the Dutch association of elderly care physicians approached, 244 participated (response rate 15%). MEASUREMENTS We explored NH physicians' perceptions of organizational, educational, financial, legal, and personal prerequisites for quality EOL care. Differences between the countries were compared using χ2 test and t-test. RESULTS Most respondents in both countries reported inadequate staffing, lack of skills among nursing personnel, and heavy time commitment for physicians as important barriers; this was more pronounced among Dutch respondents. Approximately 30% of the respondents in both countries reported their own lack of interest in EOL care as an important barrier. Suggested improvement strategies were routines for involvement of patients' family, pain- and symptom assessment protocols, EOL care guidelines, routines for advance care planning, and education in EOL care for physicians and nursing staff. CONCLUSIONS Inadequate staffing levels, as well as lack of competence, time, and interest emerge as important barriers to quality EOL care according to Dutch and Norwegian NH physicians. Their perspectives were mostly similar, despite large educational and organizational differences. Key strategies for improving EOL care in their facilities comprise education and incorporating available palliative care tools and systems.
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Affiliation(s)
- Anette Fosse
- Research Unit for General Practice, Uni Research Health, Bergen, Norway; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Sytse Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, Groningen, The Netherlands
| | - Froukje Boersma
- Department of General Practice and Elderly Care Medicine, University of Groningen, Groningen, The Netherlands
| | - Kirsti Malterud
- Research Unit for General Practice, Uni Research Health, Bergen, Norway; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Margrethe Aase Schaufel
- Research Unit for General Practice, Uni Research Health, Bergen, Norway; Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Sabine Ruths
- Research Unit for General Practice, Uni Research Health, Bergen, Norway; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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McAfee CA, Jordan TR, Sheu JJJJ, Dake JA, Kopp Miller BA. Predicting Racial and Ethnic Disparities in Advance Care Planning Using the Integrated Behavioral Model. OMEGA-JOURNAL OF DEATH AND DYING 2017; 78:30222817691286. [PMID: 28142319 DOI: 10.1177/0030222817691286] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Purpose To explain and predict racial or ethnic disparities in advance care planning (ACP) behaviors among American adults by using the Integrated Behavioral Model (IBM) and the Precaution Adoption Process Model. Methods A randomized, observational, nonexperimental, cross-sectional study design was used to survey American adults between 40 and 80 years of age ( n = 386). Results The majority of respondents (75%) had not completed ACP. Significant differences were found by race or ethnicity: 33% of Whites had completed ACP versus Hispanics (18%) and Blacks (8%). Whites had statistically significantly higher levels of most IBM constructs compared with Blacks and Hispanics. The IBM predicted 28% of the variance in behavioral intention. After controlling for sociodemographic variables, direct attitudes, indirect attitudes, and indirect perceived norms were significant predictors of behavioral intention. Conclusion The IBM and the Precaution Adoption Process Model are useful frameworks for interventions designed to increase ACP among racial or ethnic minorities in the United States.
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Smith GM, Schaefer KG. Missed opportunities to train medical students in generalist palliative care during core clerkships. J Palliat Med 2015; 17:1344-7. [PMID: 24971609 DOI: 10.1089/jpm.2014.0107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To improve the quality of care for dying patients, experts have called for all clinicians to be able to provide a generalist level of palliative care. Core clinical clerkships provide an opportunity to incorporate palliative care training to address the lack of required palliative care rotations at most U.S. medical schools. OBJECTIVE The objective of this study was to identify and quantify missed opportunities to train third-year medical students in generalist palliative care during required core clerkships. DESIGN This study was a cross-sectional survey of third-year students at a leading U.S. medical school without a required palliative care rotation. MEASUREMENTS Students completed a survey during the last 4 months of the 2012-2013 academic year quantifying and evaluating their experiences caring for dying patients. Attitudes were assessed using a scale from a national survey of students, residents, and faculty. RESULTS Eighty-eight students responded (response rate [RR]=56%). More than one-quarter (26%) never participated in caring for a patient who died. More than one-half (55%) never delivered significant bad news and 38% never worked with a specialist in palliative medicine. Eighty-four percent of students who cared for a patient who died and 60% of students who delivered significant bad news had one or more of those experiences that were not debriefed. CONCLUSIONS At an institution without a required palliative care rotation, third-year medical students rarely or never care for patients who die during core clerkships, and when they do, their teams do not debrief or reflect on these experiences. Clinical faculty, including palliative care consultants, can address missed opportunities for palliative care training during core clerkships by augmenting and routinely debriefing students' experiences giving bad news and caring for dying patients.
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Shaheen AW, Denton GD, Stratton TD, Hoellein AR, Chretien KC. End-of-life and palliative care curricula in internal medicine clerkships: a report on the presence, value, and design of curricula as rated by clerkship directors. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:1168-1173. [PMID: 24853196 DOI: 10.1097/acm.0000000000000311] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE End-of-life and palliative care (EOL/PC) education is a necessary component of undergraduate medical education. The extent of EOL/PC education in internal medicine (IM) clerkships is unknown. The purpose of this national study was to investigate the presence of formal EOL/PC curricula within IM clerkships; the value placed by IM clerkship directors on this type of curricula; curricular design and implementation strategies; and related barriers and resources. METHOD The Clerkship Directors in Internal Medicine conducted its annual survey of its institutional members in April 2012. The authors analyzed responses to survey items pertaining to formal EOL/PC curriculum and content using descriptive statistics. The authors used qualitative techniques to analyze free-text responses. RESULTS The response rate was 77.0% (94/122). Of those responding, 75.8% (69/91) believed such training should occur in the IM clerkship, and 43.6% (41/94) reported formal curricula in EOL/PC. Multiple instructional modalities were used to deliver this content, with the majority of programs dedicating four or more hours to the curriculum. Curricula covered a wide range of topics, and student assessment tools were varied. Most felt that students valued this education. The qualitative analysis revealed differences in the values clerkship directors placed on teaching EOL/PC within the IM clerkship. CONCLUSIONS Although many IM clerkship directors have implemented formal curricula in EOL/PC, a substantial gap remains between those who have implemented and those who believe it belongs in the clerkship. Time, faculty, cost, and competing demands are the main barriers to implementation.
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Affiliation(s)
- Amy W Shaheen
- Dr. Shaheen is clerkship director for the ambulatory internal medicine rotation and clinical associate professor of medicine, University of North Carolina, Chapel Hill, North Carolina. Dr. Denton is clerkship director, Primary Care Clerkship, Ochsner Clinical School-University of Queensland, New Orleans, Louisiana. Dr. Stratton is assistant dean, Assessment and Quality Management, Office of Medical Education, University of Kentucky College of Medicine, Lexington, Kentucky. Dr. Hoellein is clerkship director of internal medicine and associate professor of medicine, University of Kentucky Department of Internal Medicine, Lexington, Kentucky. Dr. Chretien is chief, Hospitalist Section, Washington DC VA Medical Center, and associate professor of medicine, George Washington University, Washington, DC
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15
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Cohen J, Van Wesemael Y, Smets T, Bilsen J, Onwuteaka-Philipsen B, Distelmans W, Deliens L. Nationwide survey to evaluate the decision-making process in euthanasia requests in Belgium: do specifically trained 2nd physicians improve quality of consultation? BMC Health Serv Res 2014; 14:307. [PMID: 25030375 PMCID: PMC4114442 DOI: 10.1186/1472-6963-14-307] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 07/11/2014] [Indexed: 11/17/2022] Open
Abstract
Background Following the 2002 enactment of the Belgian law on euthanasia, which requires the consultation of an independent second physician before proceeding with euthanasia, the Life End Information Forum (LEIF) was founded which provides specifically trained physicians who can act as mandatory consultants in euthanasia requests. This study assesses quality of consultations in Flanders and Brussels and compares these between LEIF and non-LEIF consultants. Methods A questionnaire was sent in 2009 to a random sample of 3,006 physicians in Belgium from specialties likely involved in the care of dying patients. Several questions about the last euthanasia request of one of their patients were asked. As LEIF serves the Flemish speaking community (i.e. region of Flanders and the bilingual Brussels Capital Region) and no similar counterpart is present in Wallonia, analyses were limited to Flemish speaking physicians in Flanders and Brussels. Results Response was 34%. Of the 244 physicians who indicated having received a euthanasia request seventy percent consulted a second physician in their last request; in 30% this was with a LEIF physician. Compared to non-LEIF physicians, LEIF physicians were more often not a colleague (69% vs 42%) and not a co-attending physician (89% vs 66%). They tended to more often discuss the request with the attending physician (100% vs 95%) and with the family (76% vs 69%), and also more frequently helped the attending physician with performing euthanasia (44% vs 24%). No significant differences were found in the extent to which they talked to the patient (96% vs 93%) and examined the patient file (94% vs 97%). Conclusion In cases of explicit euthanasia requests in Belgium, the consultation procedure of another physician by the attending physician is not optimal and can be improved. Training and putting at disposal consultants through forums such as LEIF seems able to improve this situation. Adding stipulations in the law about the necessary competencies and tasks of consulting physicians may additionally incite improvement. Irrespective of whether euthanasia is a legal practice within a country, similar services may prove useful to also improve quality of consultations in various other difficult end-of-life decision-making situations.
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Affiliation(s)
- Joachim Cohen
- End-of Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.
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Bolkan C, Srinivasan E, Dewar AR, Schubel S. Learning through loss: implementing lossography narratives in death education. GERONTOLOGY & GERIATRICS EDUCATION 2014; 36:124-143. [PMID: 24884824 DOI: 10.1080/02701960.2014.926268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Students may have a greater willingness to discuss issues of death and loss through written assignments; however, there is little guidance for instructors regarding how to manage these sensitive assignments, nor how students benefit from them. The authors implemented and evaluated a "lossography" assignment in an undergraduate thanatology course in which students wrote about their losses and anonymously shared these narratives with their classmates. Although many themes of loss emerged, the most frequently reported significant loss was death of a grandparent. Additionally, most significant losses occurred in childhood/adolescence. Prominent themes related to student learning included gaining self-awareness, knowledge about grief responses, and compassion for others. Students (N = 64) also completed a survey reflecting on their course learning. Of all aspects of course delivery, 44% identified the lossography as the most beneficial, whereas 97% recommended this assignment for future students. The implications of the assignment for death education are also discussed.
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Affiliation(s)
- Cory Bolkan
- a Department of Human Development , Washington State University Vancouver , Vancouver , Washington , USA
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17
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Al Qadire M. Knowledge of palliative care: an online survey. NURSE EDUCATION TODAY 2014; 34:714-718. [PMID: 24067784 DOI: 10.1016/j.nedt.2013.08.019] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 08/07/2013] [Accepted: 08/29/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND The main purpose of palliative care is to manage symptoms among patients, reduce their burden of pain, and improve their quality of life. Nurses are an essential part of the palliative care team in providing high standards of care since they spend the longest time with patients. However, lack of adequate knowledge of palliative care is considered as one of the main barriers to palliative care development and practise. OBJECTIVE To evaluate Jordanian nursing students' knowledge about palliative care. METHODS Design A quantitative research method and descriptive online-survey design were used. Settings and Participants The sample consisted of 220 students enrolled in five nursing schools (four governmental and one private) in Jordan. The Palliative Care Quiz for Nursing was used to measure students' knowledge. RESULTS The sample consisted of 220 nursing students; the mean age was 20.5, SD 2.5, and most of the students were female (67), 74 (34%) were fourth-year students and 58 (26%) were in their third year. The total mean score was low, at 8.0 (SD 3.1), ranging from 0 to 18 and the number of correctly answered statements ranged from 60 (27%, statement no. 3) to 145 (66%, statement no. 2). It was found that there were no significant impacts (H (3)=5.69, p=0.137) for place of study. However, students' knowledge was strongly affected by their academic level (H (3)=12.60, p=0.005). CONCLUSIONS Integrating palliative care education is required as the mainstay to improve students' knowledge and therefore practise. This education needs to be comprehensive in covering the basic principles of palliative care and symptom management and it should be distributed throughout the different courses to discuss palliative care within different contexts, such as elderly, paediatric and adult settings.
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Affiliation(s)
- Mohammad Al Qadire
- Doctor of Oncology and Palliative care Nursing, Faculty of Nursing, Al al-Bayt University, Mafraq 25113, Jordan.
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Evans N, Costantini M, Pasman HR, Van den Block L, Donker GA, Miccinesi G, Bertolissi S, Gil M, Boffin N, Zurriaga O, Deliens L, Onwuteaka-Philipsen B. End-of-life communication: a retrospective survey of representative general practitioner networks in four countries. J Pain Symptom Manage 2014; 47:604-619.e3. [PMID: 23932176 DOI: 10.1016/j.jpainsymman.2013.04.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 04/22/2013] [Accepted: 05/02/2013] [Indexed: 11/25/2022]
Abstract
CONTEXT Effective communication is central to high-quality end-of-life care. OBJECTIVES This study examined the prevalence of general practitioner (GP)-patient discussion of end-of-life topics (according to the GP) in Italy, Spain, Belgium, and The Netherlands and associated patient and care characteristics. METHODS This cross-sectional, retrospective survey was conducted with representative GP networks. Using a standardized form, GPs recorded the health and care characteristics in the last three months of life, and the discussion of 10 end-of-life topics, of all patients who died under their care. The mean number of topics discussed, the prevalence of discussion of each topic, and patient and care characteristics associated with discussions were estimated per country. RESULTS In total, 4396 nonsudden deaths were included. On average, more topics were discussed in The Netherlands (mean=6.37), followed by Belgium (4.45), Spain (3.32), and Italy (3.19). The topics most frequently discussed in all countries were "physical complaints" and the "primary diagnosis," whereas "spiritual and existential issues" were the least frequently discussed. Discussions were most prevalent in The Netherlands, followed by Belgium. The GPs from all countries tended to discuss fewer topics with older patients, noncancer patients, patients with dementia, patients for whom palliative care was not an important treatment aim, and patients for whom their GP had not provided palliative care. CONCLUSION The prevalence of end-of-life discussions varied across the four countries. In all countries, training priorities should include the identification and discussion of spiritual and social problems and early end-of-life discussions with older patients, those with cognitive decline if possible, and those with non-malignant diseases.
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Affiliation(s)
- Natalie Evans
- Department of Public and Occupational Health, EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands.
| | - Massimo Costantini
- Regional Palliative Care Network, IRCCS AOU San Martino-IST, Genoa, Italy
| | - H R Pasman
- Department of Public and Occupational Health, EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Lieve Van den Block
- End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel, Brussels, Belgium
| | - Gé A Donker
- Netherlands Institute of Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Guido Miccinesi
- Clinical and Descriptive Epidemiology Unit, ISPO Cancer Prevention and Research Institute, Florence, Italy
| | | | - Milagros Gil
- Public Health Directorate, Ministry of Health, Castille and León, Spain
| | - Nicole Boffin
- Scientific Institute of Public Health, Brussels, Belgium
| | - Oscar Zurriaga
- Public Health and Research General Directorate, Valencian Regional Health Administration, Valencia, Spain; Higher Public Health Research Centre, Valencia, Madrid, Spain; Spanish Consortium for Research on Epidemiology and Public Health, Madrid, Spain
| | - Luc Deliens
- Department of Public and Occupational Health, EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands; End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel, Brussels, Belgium
| | - Bregje Onwuteaka-Philipsen
- Department of Public and Occupational Health, EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands
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The impact of pediatric palliative care education on medical students' knowledge and attitudes. ScientificWorldJournal 2013; 2013:498082. [PMID: 24501581 PMCID: PMC3899714 DOI: 10.1155/2013/498082] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 10/07/2013] [Indexed: 11/17/2022] Open
Abstract
Purpose. Most undergraduate palliative care curricula omit pediatric palliative care (PPC) issues. Aim of the study was to evaluate the pilot education programme. Methods. All 391 students of Faculty of Medicine (FM) and 59 students of Division of Nursing (DN) were included in anonymous questionnaire study. Respondents were tested on their knowledge and attitude towards PPC issues before and at the end of the programme and were expected to evaluate the programme at the end. Results. For final analysis, authors qualified 375 double forms filled in correctly (320 FM and 55 DN). Before the programme, students' knowledge assessed on 0–100-point scale was low (FM: median: 43.35 points; 25%–75%: (40p–53.3p); DN: 26.7p; 13.3p–46.7p), and, in addition, there were differences (P < 0.001) between both faculties. Upon completion of the programme, significant increase of the level of knowledge in both faculties was noted (FM: 80p; 73.3–100; DN: 80p; 66.7p–80p). Participation in the programme changed declared attitudes towards some aspects of withholding of special procedures, euthanasia, and abortion. Both groups of students positively evaluated the programme. Conclusions. This study identifies medical students' limited knowledge of PPC. Educational intervention changes students' attitudes to the specific end-of-life issues. There is a need for palliative care curricula evaluation.
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Moehring B, Schildmann J, Vollmann J. End-of-Life Decisions: A Comparative Survey on (Teaching) Experiences, Views, and Ethico-Legal Knowledge of Final-Year Medical Students in Germany and France. J Palliat Med 2011; 14:1206-10. [DOI: 10.1089/jpm.2011.0184] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Berit Moehring
- Institute for Medical Ethics and History of Medicine, Ruhr-University Bochum, Germany
- Department of Internal Medicine, St. Claraspital, Basel, Switzerland
| | - Jan Schildmann
- Institute for Medical Ethics and History of Medicine, Ruhr-University Bochum, Germany
| | - Jochen Vollmann
- Institute for Medical Ethics and History of Medicine, Ruhr-University Bochum, Germany
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Dickinson GE. Thirty-five years of end-of-life issues in US medical schools. Am J Hosp Palliat Care 2011; 28:412-7. [PMID: 21282128 DOI: 10.1177/1049909110397608] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The objective of this study was to examine US medical school offerings on end-of-life issues between 1975 and 2010. Data were obtained from a mailed survey to the US medical schools in 1975, 1980, 1985, 1990, 1995, 2000, 2005, and 2010. Survey response rates for the 8 points in time (in percentages) were 95, 96, 90, 90, 93, 92, 81, and 79, respectively. Between 1975 and 2010, the overall offerings in death and dying increased so that 100% of US medical schools, beginning in 2000, offered something on death and dying. A multidisciplinary-team approach continued over the 35-year period. Palliative care is offered to some extent in 99% of US medical schools today. Numerous end-of-life topics are currently covered in the curriculum. Increased attention to end-of-life issues in medical schools should enhance medical students' relationship with terminally ill patients and their families.
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Affiliation(s)
- George E Dickinson
- Department of Sociology and Anthropology, College of Charleston, SC 29424, USA.
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