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Pennarola A, Yoshioka T, Shah D, Larson S. Primary Palliative Care Education for Graduate Medical Trainees: Impacts and Needs. Am J Hosp Palliat Care 2023; 40:387-395. [PMID: 35583487 DOI: 10.1177/10499091221102141] [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: 11/17/2022] Open
Abstract
As demand for palliative care (PC) services rise, there are insufficient numbers of PC specialists to provide PC for the US population. "Primary palliative care" refers to PC services that are administered by non-specialist PC providers. Educating trainees in graduate medical education (GME) programs is 1 strategy for expanding primary palliative care, though questions remain regarding the impact of PC education for GME trainees and where additional education is needed. This study is a multicenter, cross-sectional, web-based survey study of GME trainees assessing the needs for and impacts of primary palliative care education. The survey assessed the implementation of and participants' confidence with fundamental PC skills. The survey also asked about prior exposure to PC education and for participants' beliefs regarding areas that would be particularly helpful for future education. 170 residents and fellows from diverse training backgrounds participated in the survey out of 851 potential participants (response rate 19.98%). Exposure to PC education was associated with higher confidence and increased frequency of implementation of fundamental PC skills. Of the forms of education that were assessed, clinical/experiential education was associated most often with higher confidence and higher frequency of use of PC skills. Discussing goals of care, pain management for seriously ill patients, and communicating difficult information were those skills most frequently identified as important for additional training. This study demonstrates that by improving existing PC education or increasing access to PC education for GME trainees, it may be possible to improve primary palliative care.
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Affiliation(s)
- Adam Pennarola
- 23217Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Tammy Yoshioka
- 23217Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Dhruvi Shah
- 23217Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Sharon Larson
- 20284Main Line Health Center for Population Health Research at Lankenau Institute for Medical Research (LIMR), Wynnewood, PA, USA
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Internal medicine residents' perceptions and experiences in palliative care: a qualitative study in the United Arab Emirates. BMC Palliat Care 2022; 21:15. [PMID: 35105361 PMCID: PMC8809043 DOI: 10.1186/s12904-022-00908-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 01/27/2022] [Indexed: 11/25/2022] Open
Abstract
Background Palliative medicine is a newly developing field in the United Arab Emirates (UAE). The purpose of this study was to gain a deeper understanding of the experiences of internal medicine residents providing end-of-life care to patients and their families, and how those experiences shape their learning needs. Method Nine focus groups were conducted with internal medicine residents and recent graduates from two large academic health centers in the UAE between 2019 and 2020. Through an iterative process, data were collected and examined using constant comparison to identify themes and explore their relationships. Results Fifty-two residents and graduates participated. Residents frequently care for terminally ill patients and their families, but lack confidence in their skills and request more structured education and training. Cultural and system related factors also impact palliative care education and patient care. Five main themes and associated subthemes were identified: (1) clinical management of palliative patients, (2) patient and family communication skills, (3) religion, (4) barriers to end-of-life education, and (5) emotional impact of managing dying patients. Conclusion Our findings can help guide program development and curricular changes for internal medicine residents in the region. Structured education in end-of-life care, with a focus on fostering culturally sensitive communication skills and spirituality, can improve resident education and patient care. Clear and transparent policies at the institution level are necessary. Programs are also needed to assist residents in developing effective coping strategies and emotionally navigating experiences with patient death. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-00908-5.
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Vanhanen A, Niemi-Murola L, Pöyhiä R. Twelve Years of Postgraduate Palliative Medicine Training in Finland: How International Guidelines Are Implemented. Palliat Med Rep 2021; 2:242-249. [PMID: 34927148 PMCID: PMC8675218 DOI: 10.1089/pmr.2021.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2021] [Indexed: 11/12/2022] Open
Abstract
Background and Objective: The European Association for Palliative Care (EAPC) published recommendations for postgraduate education in palliative medicine in 2009. However, it is currently unknown how the EAPC remommendations are implemented in national programs, as audits of them are lacking. In Finland, the national society of palliative medicine has been organizing postgraduate palliative medicine training for experienced physicians since 2008, but the program has not been audited. The aim of this study was to perform a comprehensive analysis of the program. Design: In 2018-2019, a questionnaire on the Finnish Training Program for Palliative Medicine Competence was sent to past participants and delivered in person to current trainees. Learning outcomes were assessed with validated instruments for received skills and attitudes. All available educational archives were examined as well. Results: Forty-five (32 %) out of 155 specialists and 13 (38 %) out of 34 trainees responded. According to their assessments, the training provided them well with most skills required to work as palliative care specialists, but poorly with research capabilities. However, the Finnish program covers the EAPC guidelines well. Problem-based education, group work, and clinical excursions have been added to the latest curriculum. Maturation through work is needed for administrative and consultant competences. Conclusion: The EAPC guidelines can be included in a national course. The course had an important positive influence on the attitudes and learning of physicians in palliative medicine. The development of the education would benefit from pedagogical consultation. Uniform standards for auditing national programs should be developed.
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Affiliation(s)
| | - Leila Niemi-Murola
- Department of Anesthesiology and Intensive Care Medicine, University of Helsinki, Helsinki, Finland
| | - Reino Pöyhiä
- Department of Anesthesiology and Intensive Care Medicine, University of Helsinki, Helsinki, Finland
- Department of Oncology, University of Helsinki, Helsinki, Finland
- The Palliative Care Center, South Savo Social and Health Care Authority (Essote), Helsinki, Finland
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4
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Gallagher E, Carter-Ramirez D, Boese K, Winemaker S, MacLennan A, Hansen N, Hafid A, Howard M. Frequency of providing a palliative approach to care in family practice: a chart review and perceptions of healthcare practitioners in Canada. BMC FAMILY PRACTICE 2021; 22:58. [PMID: 33773579 PMCID: PMC8005234 DOI: 10.1186/s12875-021-01400-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 02/23/2021] [Indexed: 12/01/2022]
Abstract
Background Most patients nearing the end of life can benefit from a palliative approach in primary care. We currently do not know how to measure a palliative approach in family practice. The objective of this study was to describe the provision of a palliative approach and evaluate clinicians’ perceptions of the results. Methods We conducted a descriptive study of deceased patients in an interprofessional team family practice. We integrated conceptual models of a palliative approach to create a chart review tool to capture a palliative approach in the last year of life and assessed a global rating of whether a palliative approach was provided. Clinicians completed a questionnaire before learning the results and after, on perceptions of how often they believed a palliative approach was provided by the team. Results Among 79 patients (mean age at death 73 years, 54% female) cancer and cardiac diseases were the top conditions responsible for death. One-quarter of patients were assessed as having received a palliative approach. 53% of decedents had a documented discussion about goals of care, 41% had nurse involvement, and 15.2% had a discussion about caregiver well-being. These indicators had the greatest discrimination between a palliative approach or not. Agreement that elements of a palliative approach were provided decreased significantly on the clinician questionnaire from before to after viewing the results. Conclusions This study identified measurable indicators of a palliative approach in family practice, that can be used as the basis for quality improvement. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01400-4.
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Affiliation(s)
- Erin Gallagher
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada.,Division of Palliative Care, McMaster University, David Braley Health Sciences Centre 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Daniel Carter-Ramirez
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada.,Division of Palliative Care, McMaster University, David Braley Health Sciences Centre 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Kaitlyn Boese
- Division of Palliative Care, Department of Medicine, University of Ottawa, 451 Smyth, Road Ottawa, Ottawa, ON, K1H 8M5, Canada.,Department of Palliative Care, Bruyere Continuing Care, 43 Bruyère St, Ottawa, ON, K1N 5C8, Canada
| | - Samantha Winemaker
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada.,Division of Palliative Care, McMaster University, David Braley Health Sciences Centre 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Amanda MacLennan
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada.,Division of Palliative Care, McMaster University, David Braley Health Sciences Centre 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Nicolle Hansen
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Abe Hafid
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - Michelle Howard
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada.
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Kilbertus F, Ajjawi R, Archibald D. Harmony or dissonance? The affordances of palliative care learning for emerging professional identity. PERSPECTIVES ON MEDICAL EDUCATION 2020; 9:350-358. [PMID: 32856171 PMCID: PMC7718354 DOI: 10.1007/s40037-020-00608-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Patient demographics demand physicians who are competent in and embrace palliative care as part of their professional identity. Published literature describes ways that learners acquire knowledge, skills and attitudes for palliative care. These studies are, however, limited by their focus on the individual where learning is about acquisition. Viewing learning as a process of becoming through the interplay of individual, social relationships and cultures, offers a novel perspective from which to explore the affordances for professional identity development. METHODS Qualitative narrative methods were used to explore 45 narratives of memorable learning (NMLs) for palliative care recounted by 14 graduating family medicine residents in one family medicine residency program. Thematic and narrative analyses identified the affordances that support and constrain the dynamic emergence of professional identity. RESULTS Participants recounted affordances that supported and/or constrained their learning acting on personal (e.g. past experiences of death), interpersonal (e.g. professional support) and systemic (e.g. patient continuity) levels. Opportunities for developing professional identity were dynamic: factors acted in harmony, were misaligned, or colliding to support or constrain an emerging professional identity for palliative care practice. CONCLUSION Findings highlight how individual factors interplay with interpersonal and structural conditions in the workplace in dynamic and emergent ways that may support or constrain the emergence of professional identity. Viewing learning as a process of becoming allows teachers, curriculum developers and administrators to appreciate the complexity and importance of the interplay between the individual and the workplace affordances to create environments that nurture professional identity for palliative care practice.
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Affiliation(s)
- Frances Kilbertus
- Division of Clinical Science, Northern Ontario School of Medicine, Mindemoya, Ontario, Canada.
| | - Rola Ajjawi
- Centre for Research in Assessment and Digital Learning, Deakin University, Melbourne, Australia
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Ioshimoto T, Shitara DI, do Prado GF, Pizzoni R, Sassi RH, de Gois AFT. Education is an important factor in end-of-life care: results from a survey of Brazilian physicians' attitudes and knowledge in end-of-life medicine. BMC MEDICAL EDUCATION 2020; 20:339. [PMID: 33008366 PMCID: PMC7531127 DOI: 10.1186/s12909-020-02253-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 09/23/2020] [Indexed: 06/08/2023]
Abstract
BACKGROUND According to the Latin America Association for palliative care, Brazil offers only 0.48 palliative care services per 1 million inhabitants. In 2012, no accredited physicians were working in palliative care, while only 1.1% of medical schools included palliative care education in their undergraduate curricula. As a reflection of the current scenario, little research about end-of-life care has been published so that studies addressing this subject in the Brazilian setting are crucial. METHODS A cross-sectional study study conducted with students applying for the medical residency of the Federal University of São Paulo were invited to voluntarily participate in an anonymous and self-administered questionnaire survey. The latter included demographic information, attitudes, prior training in end-of-life care, prior end-of-life care experience, the 20-item Palliative Care Knowledge Test (PCKT) and a consent term. RESULTS Of the 3086 subjects applying for residency, 2349 (76%) answered the survey, 2225 were eligible for analysis while 124 were excluded due to incomplete data. Although the majority (99,2%) thought it was important to have palliative care education in the medical curriculum, less than half of them (46,2%) reported having received no education on palliative care. The overall performance in the PCKT was poor, with a mean score of 10,79 (± 3). While philosophical questions were correctly answered (81,8% of correct answers), most participants lacked knowledge in symptom control (50,7% for pain, 57,3% for dyspnea, 52,2% for psychiatric problems and 43,4% for gastrointestinal problems). Doctors that had already concluded a prior residency program and the ones that had prior experience with terminal patients performed better in the PCKT (p < 0,001). The high-performance group (more than 50% of correct answers) had received more training in end-of-life care, showed more interest in learning more about the subject, had a better sense of preparedness, as well as a higher percentage of experience in caring for terminal patients (p < 0,001). CONCLUSIONS Our study showed that Brazilian physicians lack not only the knowledge, but also training in end-of-life medicine. Important factors to better knowledge in end-of-life care were prior training, previous contact with dying patients and prior medical residency. Corroborating the literature, for this group, training showed to be a key factor in overall in this area of knowledge. Therefore, Brazilian medical schools and residency programs should focus on improving palliative training, especially those involving contact with dying patients.
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Affiliation(s)
- Thais Ioshimoto
- Departamento de Medicina. Rua Pedro de Toledo, Universidade Federal de São Paulo (UNIFESP), 719, São Paulo, SP, Brazil
- Hospital Israelita Albert Einstein (HIAE), São Paulo, SP, Brazil
| | - Danielle Ioshimoto Shitara
- Departamento de Medicina. Rua Pedro de Toledo, Universidade Federal de São Paulo (UNIFESP), 719, São Paulo, SP, Brazil
| | - Gilmar Fernades do Prado
- Departamento de Medicina. Rua Pedro de Toledo, Universidade Federal de São Paulo (UNIFESP), 719, São Paulo, SP, Brazil
| | - Raymon Pizzoni
- Departamento de Medicina. Rua Pedro de Toledo, Universidade Federal de São Paulo (UNIFESP), 719, São Paulo, SP, Brazil.
| | - Rafael Hennemann Sassi
- Departamento de Medicina. Rua Pedro de Toledo, Universidade Federal de São Paulo (UNIFESP), 719, São Paulo, SP, Brazil
| | - Aécio Flávio Teixeira de Gois
- Departamento de Medicina. Rua Pedro de Toledo, Universidade Federal de São Paulo (UNIFESP), 719, São Paulo, SP, Brazil
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Spiker M, Paulsen K, Mehta AK. Primary Palliative Care Education in U.S. Residencies and Fellowships: A Systematic Review of Program Leadership Perspectives. J Palliat Med 2020; 23:1392-1399. [DOI: 10.1089/jpm.2020.0331] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Michael Spiker
- Palliative Care, Department of Medicine, VA Greater Los Angeles, University of California, Los Angeles, Los Angeles, California, USA
| | - Kate Paulsen
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Ambereen K. Mehta
- Palliative Care Program, Department of Medicine, University of California, Los Angeles Medical Center, Santa Monica, California, USA
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8
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Lasmarías C, Guanter L, Turrillas P, Peñafiel J, Gómez-Batiste X. Evaluating the impact of a multidisciplinary master programme in palliative care on professional learning outcomes: a cross-sectional study after 20 years of experience. BMJ Support Palliat Care 2020:bmjspcare-2020-002528. [PMID: 32994188 DOI: 10.1136/bmjspcare-2020-002528] [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: 06/25/2020] [Revised: 08/19/2020] [Accepted: 08/24/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess the impact after 20 years of a Master's degree in palliative care (MsPC) on the participants' educational outcomes in terms of educational needs satisfaction, motivation, applicability and professional development (PD) in the palliative care (PC) field. METHODS A cross-sectional study was conducted between October 2016 and February 2017. Participants were students of the MsPC from 13 editions. An ad hoc survey comprising closed-end questions was provided. Variables such as sociodemographic and learning outcomes, based on Kirkpatrick's model, were included. RESULTS Respondents were 76.6% women, and 60% were between 30 and 50 years of age. Over half of participants were physicians (57.4%), with >15 years of experience (52%). 77% (n=152) reported previous work experience (PWE) in PC, and 23% (n=45) had no PWE. After completing the MsPC, 49% of those without PWE were hired to work in a PC unit, while 84,2% with PWE continued work in a PC-related position. 51.6% professionals with PWE were currently working in other PC areas, such as training or research. High scores were observed on expectations, training needs, motivation in professional practice, PD, applicability and satisfaction, in both groups. Data have shown statistically significant differences on the perceived value of the MsPC to obtain work in the PC field (p=0.006). CONCLUSIONS This MsPC training programme improves educational outcomes, and promotes PD, regardless of PWE in PC. Interdisciplinary training for all professionals who care for PC individuals is required. To ensure the quality of education in PC programmes, a systematic process of continuous evaluation is needed.
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Affiliation(s)
- Cristina Lasmarías
- Education and Training, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Catalunya, Spain
- Catalonia Chronic Care Research Group, Universitat de Vic-Universitat Central de Catalunya, Vic, Catalunya, Spain
| | - Lourdes Guanter
- Education and Training, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Catalunya, Spain
| | - Pamela Turrillas
- Chair of Palliative Care, Universitat de Vic-Universitat Central de Catalunya, Vic, Catalunya, Spain
- The 'Qualy' Observatory, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Catalunya, Spain
| | - Judith Peñafiel
- Department of Statistics, Biomedical Research Institute of Bellvitge, IDIBELL, Barcelona, Spain
| | - Xavier Gómez-Batiste
- Catalonia Chronic Care Research Group, Universitat de Vic-Universitat Central de Catalunya, Vic, Catalunya, Spain
- Chair of Palliative Care, Universitat de Vic-Universitat Central de Catalunya, Vic, Catalunya, Spain
- The 'Qualy' Observatory, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Catalunya, Spain
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9
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Paulsen K, Wu DS, Mehta AK. Primary Palliative Care Education for Trainees in U.S. Medical Residencies and Fellowships: A Scoping Review. J Palliat Med 2020; 24:354-375. [PMID: 32640863 DOI: 10.1089/jpm.2020.0293] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: The medical profession increasingly recognizes the growing need to educate nonpalliative physicians in palliative care. Objective: This study aims to provide a scoping review of the primary palliative care (PPC) education currently available to graduate medical trainees in primary and specialty tracks. Design: Studies of PPC interventions in U.S. residency or fellowship programs of all subspecialties published in English and listed on MEDLINE, CINAHL, and EMBASE through January 2020 were included. To meet admission criteria, studies had to describe the content, delivery methods, and evaluation instruments of a PPC educational intervention. Results: Of 233 eligible full texts, 85 studies were included for assessment, of which 66 were novel PPC educational interventions and 19 were standard education. Total number of publications evaluating PPC education increased from 8 (2000-2004) to 36 (2015-2019), across 11 residency and 10 fellowship specialties. Residency specialties representing the majority of publications were emergency medicine, general surgery, internal medicine, and pediatric/medicine-pediatrics. PPC content domains most taught in residencies were communication and symptom management; the primary delivery method was didactics, and the outcome assessed was attitudes. Fellowship specialties representing the majority of publications were pediatric subspecialties, nephrology, and oncology. The PPC content domain most taught in fellowships was communication; the primary delivery method was didactics and the outcome evaluated was attitudes. Conclusions: While PPC education has increased, it remains varied in content, delivery method, and intervention evaluations. Future studies should include more widespread evaluation of behavioral outcomes, longitudinal persistence of use, and clinical impact.
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Affiliation(s)
- Kate Paulsen
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - David S Wu
- Palliative Care Program, Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Ambereen K Mehta
- Palliative Care Program, Department of Medicine, University of California, Los Angeles Medical Center, Santa Monica, California, USA
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10
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Dehghani F, Barkhordari-Sharifabad M, Sedaghati-Kasbakhi M, Fallahzadeh H. Effect of palliative care training on perceived self-efficacy of the nurses. BMC Palliat Care 2020; 19:63. [PMID: 32366232 PMCID: PMC7199299 DOI: 10.1186/s12904-020-00567-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 04/22/2020] [Indexed: 11/12/2022] Open
Abstract
Background Nurses are involved in providing end-of-life care for end stage individuals and their self-efficacy is one of the key factors bearing on such care. The purpose of this study was to determine the effect of palliative care on perceived self-efficacy of the nurses. Methods This is a quasi-experimental study with pretest-posttest design. Sampling was randomized and included 40 individuals. The intervention consisted of palliative care training for four sessions, each lasting 45 min. Data were collected using demographic and perceived self-efficacy questionnaires completed before and after the intervention. Data were then analyzed by SPSS 16 software using descriptive and inferential statistics. Results The mean age of the participants was 38.6 and their work experience was 14.25 years. The majority of the participants were female (85%) and had a bachelor level of education (92.5%). The findings showed that “perceived self-efficacy”, “psychosocial support” and “symptom management” improved significantly after intervention (p < 0.05). Conclusion Based on the results, palliative care education has the potential to increase nurses’ perceived self-efficacy. Since all members of the health care team Including nurses play an important role in providing palliative care, nursing managers can take an effective step to maximize the capacity of nurses by planning and supporting training in this regard.
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Affiliation(s)
- Fatemeh Dehghani
- Department of Nursing, School of Medical Sciences, Yazd Branch, Islamic Azad University, Shohadaye Gomnam Blvd., Safaiyeh, Yazd, 8916871967, Iran
| | - Maasoumeh Barkhordari-Sharifabad
- Department of Nursing, School of Medical Sciences, Yazd Branch, Islamic Azad University, Shohadaye Gomnam Blvd., Safaiyeh, Yazd, 8916871967, Iran.
| | - Maryam Sedaghati-Kasbakhi
- Department of Nursing, School of Medical Sciences, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran
| | - Hossein Fallahzadeh
- Department of Biostatistics and Epidemiology, Faculty of Health, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
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Rodenbach R, Kavalieratos D, Tamber A, Tapper C, Resick J, Arnold R, Childers J. Coaching Palliative Care Conversations: Evaluating the Impact on Resident Preparedness and Goals-of-Care Conversations. J Palliat Med 2019; 23:220-225. [PMID: 31460823 DOI: 10.1089/jpm.2019.0165] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: There is increasing need for nonspecialty physicians to deliver palliative care (PC) services to meet patient needs, but many physicians feel inadequately prepared. Objective: We aimed to improve the PC skills of resident physicians through a learner-centered, just-in-time coaching intervention. Design: Our quality improvement initiative consisted of two didactics and brief thrice-weekly coaching sessions that focused on real-time PC questions. Upper level internal medicine residents participated during an inpatient hospitalist rotation. Measurements: Residents completed pre/postrotation surveys of their preparedness in discussing PC topics. Electronic medical record data of documentation of goals-of-care (GOC) discussions and Physician Orders for Life-Sustaining Treatment (POLST) completion in at-risk hospitalized patients (age >65 with two or more hospitalizations in the past six months, or age >90) were obtained and compared with before hospitalization. These data were also compared with data from patients on the same resident hospitalist service during the six-month period before the intervention began. Results: During the 14-month intervention period, 42 residents cared for 232 at-risk patients. Among at-risk patients, 12.9% had a documented GOC discussion before hospitalization, which rose to 57.3% before discharge. Among at-risk patients preintervention, these rates were 5.2% and 25.0%, respectively. Residents reported their preparedness increased across many elements of GOC discussions and rated coaching sessions as useful and relevant to their training. Rates of POLST completion did not differ between preintervention and intervention groups. Conclusions: Brief coaching sessions can integrate PC education into a busy clinical service, improve residents' primary PC skills, and improve GOC documentation.
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Affiliation(s)
- Rachel Rodenbach
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dio Kavalieratos
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anoo Tamber
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Corey Tapper
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Judith Resick
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Robert Arnold
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Julie Childers
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Moyer KM, Morrison LJ, Encandela J, Kennedy C, Ellman MS. A New Competency-Based Instrument to Assess Resident Knowledge and Self-Efficacy in Primary Palliative Care. Am J Hosp Palliat Care 2019; 37:117-122. [PMID: 31213089 DOI: 10.1177/1049909119855612] [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] [Indexed: 11/15/2022] Open
Abstract
CONTEXT There is a need to improve both primary palliative care (PPC) education and its assessment in graduate medical education (GME). We developed an instrument based on published palliative care (PC) competencies to assess resident competency and educational interventions. OBJECTIVES To describe the development and psychometric properties of a novel, competency-based instrument to measure resident knowledge and self-efficacy in PPC. METHODS We created a 2-part instrument comprised of a knowledge test (KT) and a self-efficacy inventory (SEI) addressing 18 consensus, core PC resident competencies across 5 domains: pain and symptom management; communication; psychosocial, spiritual, and cultural aspects of care; terminal care and bereavement; and PC principles and practice. The instrument was distributed to 341 internal medicine residents during academic years 2015 to 2016 and 2016 to 2017. A standard item analysis was performed on the KT. Internal consistency (Cronbach α) and variable relationships (factor analysis) were measured for the SEI. RESULTS One hundred forty-four residents completed the survey (42% response). For 15 KT items, difficulty ranged from 0.17 to 0.98, with 7 items ranging 0.20 to 0.80 (typical optimum difficulty); discrimination ranged from 0.03 to 0.60 with 10 items ≥0.27 (good to very good discrimination). Cronbach α was 0.954 for 35 SEI items. Factor analysis of combined 2015 to 2016 items yielded 4 factors explaining the majority of variance for the entire set of variables. CONCLUSION Our instrument demonstrates promising psychometric properties and reliability in probing the constructs of PC and can be further utilized in PC GME research to assess learners and evaluate PPC educational interventions.
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Affiliation(s)
- Kristen M Moyer
- Advanced Illness Management Team, Departments of Anesthesia and Internal Medicine, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA
| | - Laura J Morrison
- Section of Geriatrics, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - John Encandela
- Department of Psychiatry and Teaching and Learning Center, Yale School of Medicine, New Haven, CT, USA
| | - Catherine Kennedy
- Teaching and Learning Center, Yale School of Medicine, New Haven, CT, USA
| | - Matthew S Ellman
- Section of General Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
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Inoue A, Yamaguchi T, Tanaka K, Sakashita A, Aoe K, Seki N, Hagiwara K. Benefits of a Nationwide Palliative Care Education Program on Lung Cancer Physicians. Intern Med 2019; 58:1399-1403. [PMID: 30713293 PMCID: PMC6548920 DOI: 10.2169/internalmedicine.0872-18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 07/16/2018] [Indexed: 01/22/2023] Open
Abstract
Objective The early integration of palliative care into standard cancer treatment has become a global standard. The Palliative care Emphasis program on symptom management and Assessment for Continuous medical Education (PEACE) has been conducted in Japan, and previous studies have reported that the PEACE workshop was able to improve various palliative care skills of participants. However, whether or not the effects of the program are long-lasting and if the program consequently changed physicians' practice with regard to lung cancer patients have been unclear. Methods Web-based surveys, including the palliative care knowledge test (PEACE-Q), the Palliative Care self-reported Practice Scale (PCPS), and the Palliative Care Difficulties Scale (PCDS), were conducted among lung cancer physicians in Japan. The differences in the survey results between participants and non-participants of the PEACE workshop were examined. Results Among 923 respondents (455 respiratory physicians, 345 pulmonary surgeons, and 123 others), 519 had participated in the PEACE workshop. The total PEACE-Q score was significantly higher in the PEACE workshop participants than in non-participants (28.0 versus 24.5, p<0.0001). The score was significantly higher in respiratory physicians than in pulmonary surgeons (27.4 versus 25.5). The total PCPS and PCDS scores were also significantly better in workshop participants than in non-participants (71.8 versus 67.1 and 34.3 versus 36.9, respectively), although some domains of PCDS were similar between the groups. Conclusion The PEACE program improved the knowledge and practices with regard to palliative care and resolved difficulties associated therewith among lung cancer physicians. In regions where palliative care specialists are insufficient, such educational programs may be effective.
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Affiliation(s)
- Akira Inoue
- Department of Palliative Medicine, Tohoku University School of Medicine, Japan
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Japan
| | - Keiko Tanaka
- Department of Palliative Care, Tokyo Metropolitan Cancer & Infectious Diseases Center Komagome Hospital, Japan
| | - Akihiro Sakashita
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Japan
| | - Keisuke Aoe
- Department of Medical Oncology, Yamaguchi-Ube Medical Center, Japan
| | - Nobuhiko Seki
- Division of Medical Oncology, Department of Internal Medicine, Teikyo University School of Medicine, Japan
| | - Koichi Hagiwara
- Division of Pulmonary Medicine, Department of Internal Medicine, Jichi Medical University, Japan
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14
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Turrillas P, Teixeira MJ, Maddocks M. A Systematic Review of Training in Symptom Management in Palliative Care Within Postgraduate Medical Curriculums. J Pain Symptom Manage 2019; 57:156-170.e4. [PMID: 30287198 DOI: 10.1016/j.jpainsymman.2018.09.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 09/18/2018] [Accepted: 09/20/2018] [Indexed: 11/23/2022]
Abstract
CONTEXT Symptom management is a priority area within palliative care core competencies for generalist providers. Although several educational initiatives exist, a comprehensive evidence synthesis on the effectiveness of symptom management training on trainees' learning and patient-reported outcomes is lacking. OBJECTIVES The objective of this study was to determine the effectiveness of training in symptom management in palliative care providers in nonpalliative specialties. METHODS This is a systematic review following Best Evidence Medical Education methods from searches of MEDLINE, EMBASE, ERIC, CINAHL, PsycINFO, Cochrane database of systematic, Clinical Trials.gov, and ISRCTN databases to September 2017. Prospective controlled studies testing the impact of symptom management educational interventions on physicians in training in nonpalliative specialties were included. Data were summarized narratively, grouped by curriculum description, and effectiveness on trainees' learning or patient-reported outcomes. RESULTS Of 5062 records identified, six studies met the inclusion criteria: two randomized controlled trials and four quasi-experimental. Pain management and use of opioids and their side effects were most frequently covered. Clinical decision support tools, Web-based teaching, palliative care rotation, and mixed educational methods were used. Most studies used self-reported, original, or modified evaluation instruments, although psychometric properties were seldom reported. Despite methodological considerations, all educational methods improved trainees' learning outcomes. However, the effects on trainees' behavior and patient-related outcomes were not evaluated. CONCLUSION Current educational training programs in symptom management appear to improve trainees' comfort, preparedness, and knowledge in assessing and managing patients' symptoms at the end of life. More rigorous research to evaluate the impact of this training on residents and organizational performance is now required.
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Affiliation(s)
- Pamela Turrillas
- Department of Palliative Care, Policy, and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK.
| | - Maria Joao Teixeira
- Department of Palliative Care, Policy, and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | - Matthew Maddocks
- Department of Palliative Care, Policy, and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
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15
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A Network Approach to Neonatal Palliative Care Education: Impact on Knowledge, Efficacy, and Clinical Practice. J Perinat Neonatal Nurs 2019; 33:350-360. [PMID: 31651629 DOI: 10.1097/jpn.0000000000000437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
More than 80 000 babies are admitted to specialist neonatal units in the United Kingdom every year, with approximately 2109 neonatal deaths a year; 98% in hospital. A common element in guidance and pathways to facilitate the provision of palliative care to infants and their families is the importance of good education and training to develop high-quality staff and services. This article presents a mixed-methods, sequential, explanatory design evaluation of 1 day palliative care education workshops delivered using a network-wide approach to multidisciplinary professionals. Workshops were delivered by healthcare professionals and bereaved parents and evaluated using questionnaires, adapted for neonatal staff from standardized measures, and follow-up interviews. The workshop content and shared learning approach resulted in significant improvements in participant's knowledge, attitude, self-beliefs and confidence in neonatal palliative care, enhanced awareness of services, and improved links between professionals. Participants cascaded their learning to their teams and provided examples of changes in their clinical practice following the workshop. Parent stories were identified as a very powerful component of the training, with lasting impact on participants. Formal, integrated palliative care education programs for perinatal and neonatal staff and longitudinal research into the impact on practice and the experience received by families are needed.
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16
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Westcott AM, Wolpaw DR, Riddle JM. Pilot Qualitative Study of Informal Teachers in Interprofessional Collaboration and Practice. J Pain Symptom Manage 2019; 57:108-111. [PMID: 30367927 DOI: 10.1016/j.jpainsymman.2018.10.499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/15/2018] [Accepted: 10/16/2018] [Indexed: 11/17/2022]
Abstract
CONTEXT Nonphysician members of the interprofessional palliative care team often participate in teaching physicians and others in the context of workplace learning due to the interprofessional collaborative nature of the specialty. OBJECTIVES This pilot study examines the beliefs of the nonphysician members of the interprofessional team about teaching physicians-in-training, the disciplinary training and expertise that informs their teaching, and approaches to teaching in the workplace. METHODS Semistructured interviews were conducted. All interviews were audio recorded and transcribed verbatim. Initial open coding by two researchers identified the codes, and then the constant comparative method was used to find patterns by axial coding, categories, and themes within the data. RESULTS Of the 10 health care professionals involved with palliative medical education at one academic medical center, six enrolled in the pilot. Those who participated included chaplains, nurses, a social worker, and a physician assistant. Three major themes were identified from the informal teachers: 1) using professional identity as a foundation for teaching, 2) teaching through experiential learning or debriefing, and 3) teaching to perceived gaps in physician training. CONCLUSION Nonphysician members of the interprofessional team interacted with physicians-in-training guided by their discipline-based skills and perspectives on patient care. They directed their informal teaching toward perceived educational gaps using reflection and debriefing. Future studies could explore the educational roles of health care professionals across diverse institutions and specialties.
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Affiliation(s)
- Amy M Westcott
- Penn State College of Medicine, Hershey, Pennsylvania, USA.
| | | | - Janet M Riddle
- University of Illinois - Chicago, Chicago, Illinois, USA
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17
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Kilbertus F, Ajjawi R, Archibald DB. "You're Not Trying to Save Somebody From Death": Learning as "Becoming" in Palliative Care. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:929-936. [PMID: 29116978 DOI: 10.1097/acm.0000000000001994] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE Learning can be conceptualized as a process of "becoming," considering individuals, workplace participation, and professional identity formation. How postgraduate trainees learn palliative care, encompassing technical competence, compassion, and empathy, is not well understood or explained by common conceptualizations of learning as "acquisition" and "participation." Learning palliative care, a practice that has been described as a cultural shift in medicine challenging the traditional role of curing and healing, provided the context to explore learning as "becoming." METHOD The authors undertook a qualitative narrative study, interviewing 14 residents from the University of Ottawa Family Medicine Residency Program eliciting narratives of memorable learning (NMLs) for palliative care. Forty-five NMLs were analyzed thematically. To illuminate the interplay among themes, an in-depth analysis of the NMLs was done that considered themes and linguistic and paralinguistic features of the narratives. RESULTS Forty-five NMLs were analyzed. The context of NMLs was predominantly a variety of clinical workplaces during postgraduate training. Themes clustered around the concept of palliative care and how it contrasted with other clinical experiences, the emotional impact on narrators, and how learning happened in the workplace. Participants had expectations about their identities as doctors that were challenged within their NMLs for palliative care. CONCLUSIONS NMLs for palliative care were a complex entanglement of individual experience and social and workplace cultures highlighting the limitations of the "acquisition" and "participation" metaphors of learning. By conceptualizing learning as "becoming," what occurs during memorable learning can be made accessible to those supporting learners and their professional identity formation.
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Affiliation(s)
- Frances Kilbertus
- F. Kilbertus is family physician and associate professor, Department of Clinical Sciences, Northern Ontario School of Medicine, Mindemoya, Ontario, Canada. R. Ajjawi is senior research fellow, Centre for Research in Assessment and Digital Learning, Deakin University, Melbourne, Victoria, Australia. D.B. Archibald is assistant professor and medical education research scientist, Department of Family Medicine, University of Ottawa and Bruyère Research Institute, Ottawa, Ontario, Canada
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18
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Connolly M, McLean S, Guerin S, Walsh G, Barrett A, Ryan K. Development and Initial Psychometric Properties of a Questionnaire to Assess Competence in Palliative Care: Palliative Care Competence Framework Questionnaire. Am J Hosp Palliat Care 2018; 35:1304-1308. [DOI: 10.1177/1049909118772565] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Although the provision of palliative care (PC) is fundamental to the role of the physician, little research has assessed the competence of trainee and experienced physicians in PC. Aim: To describe the development of a competence questionnaire and assess the level of competence of medical doctors in Ireland to provide PC to individuals with life-limiting conditions and their families. Design: A survey-based cohort study was employed using a questionnaire based on the Palliative Care Competence Framework, developed specifically for this study. Setting: The sample was accessed via the Royal College of Physicians of Ireland. All specialties in adult medical care and direct patient contact were included. Results: A pilot study demonstrated comprehensiveness and ensured face validity. In the main study, all subscales showed internal reliability and evidence of a normal distribution. Strong correlation was noted between knowledge and behavior while moderate correlations were noted between attitudes and behavior and attitudes and knowledge, respectively. As expected, palliative-trained participants scored significantly higher in attitudes, behavior, and knowledge. Conclusions: The study provides baseline data on the level of competence of PC of doctors working in Ireland. The study also offers a novel assessment tool that has the potential to be used for future research.
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Affiliation(s)
- Michael Connolly
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin, Ireland
| | | | - Suzanne Guerin
- School of Psychology, University College Dublin, Belfield, Dublin, Ireland
| | - Gillian Walsh
- Education Development Department, Royal College of Physicians of Ireland, Dublin, Ireland
| | - Aileen Barrett
- Education Development Department, Royal College of Physicians of Ireland, Dublin, Ireland
| | - Karen Ryan
- St Francis Hospice, Raheny, Dublin, Ireland
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19
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Nakazawa Y, Kato M, Miyashita M, Morita T, Kizawa Y. Changes in Nurses' Knowledge, Difficulties, and Self-reported Practices Toward Palliative Care for Cancer Patients in Japan: An Analysis of Two Nationwide Representative Surveys in 2008 and 2015. J Pain Symptom Manage 2018; 55:402-412. [PMID: 28919540 DOI: 10.1016/j.jpainsymman.2017.08.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/30/2017] [Accepted: 08/30/2017] [Indexed: 10/18/2022]
Abstract
CONTEXT The Cancer Control Act was passed in Japan in 2007, and various additional programs on palliative care have been implemented to improve quality of life and relieve pain and suffering in patients with cancer. However, how clinical settings have changed remains unclear. OBJECTIVES The primary aim of the present study was to determine changes in nurses' palliative care knowledge, difficulties, and self-reported practices between 2008 and 2015. METHODS This study was an analysis of two nationwide observational studies from 2008 to 2015. We conducted two questionnaire surveys for representative samples of nurses in designated cancer hospitals, community hospitals, and district nurse services. The measurements used the Palliative Care Knowledge Test (PCKT, range 1-100), the Palliative Care Difficulties Scale (PCDS, range 1-5), and the Palliative Care Self-Reported Practice Scale (PCPS, range 1-5). Comparisons were made using the nonpaired Student t-test and a multivariate linear regression model using two cohorts. RESULTS We analyzed survey results for 2707 nurses in 2008 and 3649 nurses in 2015. Significant improvements were seen in PCKT, PCDS, and PCPS total scores for nurses in every work location over the seven-year study period, with PCKT total scores of 53 vs. 65 (P < 0.001; effect size = 0.60), 47 vs. 55 (P < 0.001; effect size = 0.40), and 52 vs. 55 (P = 0.118; effect size = 0.13), PCDS total scores of 3.0 vs. 2.5 (P < 0.001; effect size = 0.76), 3.4 vs. 2.8 (P < 0.001, effect size = 0.91), and 3.2 vs. 2.9 (P < 0.001; effect size = 0.53), and PCPS total scores of 3.7 vs. 4.0 (P < 0.001; effect size = 0.13), 3.5 vs. 3.8 (P < 0.001; effect size = 0.42), and 3.8 vs. 4.0 (P < 0.011; effect size = 0.21) in designated cancer hospitals, community hospitals, and district nurse services, respectively. CONCLUSION Nurses' palliative care knowledge, difficulties, and self-reported practices improved over the seven-year study period, especially in terms of expert support in designated cancer hospitals and knowledge among nurses in designated cancer hospitals.
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Affiliation(s)
- Yoko Nakazawa
- Division of Medical Support and Partnership, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan; Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
| | - Masashi Kato
- Division of Medical Support and Partnership, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Japan
| | - Yoshiyuki Kizawa
- Division of Palliative Medicine, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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20
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Rossfeld ZM, Tumin D, Humphrey LM. Self-Assessment of Skills and Competencies among Residents Participating in a Pediatric Hospice and Palliative Medicine Elective Rotation. J Palliat Med 2018; 21:229-235. [DOI: 10.1089/jpm.2017.0201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Zachary M. Rossfeld
- Section of Hospice and Palliative Care, Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Dmitry Tumin
- Section of Hospice and Palliative Care, Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Lisa M. Humphrey
- Section of Hospice and Palliative Care, Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio
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21
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Nakazawa Y, Yamamoto R, Kato M, Miyashita M, Kizawa Y, Morita T. Improved knowledge of and difficulties in palliative care among physicians during 2008 and 2015 in Japan: Association with a nationwide palliative care education program. Cancer 2017; 124:626-635. [DOI: 10.1002/cncr.31071] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/10/2017] [Accepted: 09/14/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Yoko Nakazawa
- Division of Medical Support and Partnership; Center for Cancer Control and Information Services, National Cancer Center; Tokyo Japan
- Department of Palliative Nursing, Health Sciences; Tohoku University Graduate School of Medicine; Miyagi Japan
| | - Ryo Yamamoto
- Department of Palliative Medicine; Saku Central Hospital Advanced Care Center; Nagano Japan
| | - Masashi Kato
- Division of Medical Support and Partnership; Center for Cancer Control and Information Services, National Cancer Center; Tokyo Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences; Tohoku University Graduate School of Medicine; Miyagi Japan
| | - Yoshiyuki Kizawa
- Division of Palliative Medicine; Kobe University Hospital, Kobe University School of Medicine; Hyogo Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care; Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital; Shizuoka Japan
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22
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Harris JA, Herrel LA, Healy MA, Wancata LM, Perumalswami CR. Milestones for the Final Mile: Interspecialty Distinctions in Primary Palliative Care Skills Training. J Pain Symptom Manage 2016; 52:345-352.e5. [PMID: 27260828 DOI: 10.1016/j.jpainsymman.2016.03.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 02/05/2016] [Accepted: 03/07/2016] [Indexed: 10/21/2022]
Abstract
CONTEXT Primary palliative care (PPC) skills are useful in a wide variety of medical and surgical specialties, and the expectations of PPC skill training are unknown across graduate medical education. OBJECTIVES We characterized the variation and quality of PPC skills in residency outcomes-based Accreditation Council for Graduate Medical Education (ACGME) milestones. METHODS We performed a content analysis with structured implicit review of 2015 ACGME milestone documents from 14 medical and surgical specialties chosen for their exposure to clinical situations requiring PPC. For each specialty milestone document, we characterized the variation and quality of PPC skills in residency outcomes-based ACGME milestones. RESULTS We identified 959 occurrences of 29 palliative search terms within 14 specialty milestone documents. Within these milestone documents, implicit review characterized 104 milestones with direct saliency to PPC skills and 196 milestones with indirect saliency. Initial interrater agreement of the saliency rating among the primary reviewers was 89%. Specialty milestone documents varied widely in their incorporation of PPC skills within milestone documents. PPC milestones were most commonly found in milestone documents for Anesthesiology, Pediatrics, Urology, and Physical Medicine and Rehabilitation. PPC-relevant milestones were most commonly found in the Interpersonal and Communication Skills core competency with 108 (36%) relevant milestones classified under this core competency. CONCLUSIONS Future revisions of specialty-specific ACGME milestone documents should focus on currently underrepresented, but important PPC skills.
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Affiliation(s)
- John A Harris
- Robert Wood Johnson Foundation Clinical Scholars Program, Institute for Healthcare Policy and Innovation, and Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA.
| | - Lindsey A Herrel
- Dow Division of Urologic Health Services Research, Department of Urology, and Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Mark A Healy
- Department of Surgery and Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan, USA
| | - Lauren M Wancata
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Chithra R Perumalswami
- Robert Wood Johnson Foundation Clinical Scholars Program/U.S. Department of Veterans Affairs, Institute for Healthcare Policy and Innovation, and Division of Geriatrics and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Schram AW, Hougham GW, Meltzer DO, Ruhnke GW. Palliative Care in Critical Care Settings: A Systematic Review of Communication-Based Competencies Essential for Patient and Family Satisfaction. Am J Hosp Palliat Care 2016; 34:887-895. [PMID: 27582376 DOI: 10.1177/1049909116667071] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND There is an emerging literature on the physician competencies most meaningful to patients and their families. However, there has been no systematic review on physician competency domains outside direct clinical care most important for patient- and family-centered outcomes in critical care settings at the end of life (EOL). Physician competencies are an essential component of palliative care (PC) provided at the EOL, but the literature on those competencies relevant for patient and family satisfaction is limited. A systematic review of this important topic can inform future research and assist in curricular development. METHODS Review of qualitative and quantitative empirical studies of the impact of physician competencies on patient- and family-reported outcomes conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines for systematic reviews. The data sources used were PubMed, MEDLINE, Web of Science, and Google Scholar. RESULTS Fifteen studies (5 qualitative and 10 quantitative) meeting inclusion and exclusion criteria were identified. The competencies identified as critical for the delivery of high-quality PC in critical care settings are prognostication, conflict mediation, empathic communication, and family-centered aspects of care, the latter being the competency most frequently acknowledged in the literature identified. CONCLUSION Prognostication, conflict mediation, empathic communication, and family-centered aspects of care are the most important identified competencies for patient- and family-centered PC in critical care settings. Incorporation of education on these competencies is likely to improve patient and family satisfaction with EOL care.
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Affiliation(s)
- Andrew W Schram
- 1 Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | | | - David O Meltzer
- 3 Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA.,4 Center for Health and the Social Sciences, University of Chicago, Chicago, IL, USA
| | - Gregory W Ruhnke
- 3 Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
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Thoonsen B, Groot M, Verhagen S, van Weel C, Vissers K, Engels Y. Timely identification of palliative patients and anticipatory care planning by GPs: practical application of tools and a training programme. BMC Palliat Care 2016; 15:39. [PMID: 27044254 PMCID: PMC4820918 DOI: 10.1186/s12904-016-0112-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 03/22/2016] [Indexed: 12/25/2022] Open
Abstract
Background Palliative care is mainly restricted to terminal care. General practitioners (GPs) are not trained to early identify palliative patients with cancer, COPD or heart failure. With the help of the RADboud indicators for PAlliative Care needs (RADPAC), we trained GPs to identify patients’ needs and to make a proactive care plan. They were also able to join two role-plays where they discussed the patient’s future, and consulted a palliative care consultant to fine-tune the care plan. We evaluated the programme with the GPs and consultants and noted its impact on their daily practice. Methods Two years after they had participated in the programme, we held semi-structured interviews with the GPs and a focus group interview with the consultants and performed a thematic content analysis. Results Six consultants and nine GPs participated in the programme. Most GPs and consultants mentioned positive changes in the thinking or acting of GPs regarding early palliative care. A number continued to use the tool to identify patients; most of the others noted they had internalised the indicators. Although half of them still considered discussing end-of-life aspects difficult, particularly in patients with organ failure, the others were more easily able to discuss the future with their palliative patients. Conclusion Although most GPs and consultants were positive about the training programme and applying it in daily practice, we conclude that in future programmes, more attention needs to paid to timely identification of palliative patients with COPD or CHF and how to discuss the future with them.
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Affiliation(s)
- Bregje Thoonsen
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marieke Groot
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Stans Verhagen
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Chris van Weel
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Health Services Research and Quality, Australian National University, Canberra, Australia
| | - Kris Vissers
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Yvonne Engels
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands. .,Radboud University Medical Center, Post box 9101, Internal code 549, 6500 HB, Nijmegen, The Netherlands.
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25
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Harrison KL, Boyden JY, Kalish VB, Muir JC, Richardson S, Connor SR. A Hospice Rotation for Military Medical Residents: A Mixed Methods, Multi-Perspective Program Evaluation. J Palliat Med 2016; 19:542-8. [PMID: 27139524 DOI: 10.1089/jpm.2015.0339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND An estimated 6,000 to 18,000 additional hospice and palliative medicine (HPM) physicians are needed in the United States. A source could be the military graduate medical education system where 15% of U.S. medical residents are trained. A community-based hospice and palliative care organization created a one-week rotation for military residents including participation in interdisciplinary group visits at patients' homes, facilities, and an inpatient hospice unit. OBJECTIVE Our goal was to evaluate the effectiveness of a one-week community HPM rotation for military medical residents. METHODS A mixed-methods, multi-stakeholder perspective program evaluation model was used for program years 2011 to 2013. Data were managed and analyzed using Microsoft Excel and Atlas.ti. Participants in the rotation were residents training at two local military hospitals. Program evaluation data were collected from residents, military program liaisons, and hospice clinical preceptors. Quantitative data included pre- and post-tests based on Accreditation Council for Graduate Medical Education competencies completed by residents. Qualitative data included resident essays and semi-structured interviews with hospice preceptors and military program liaisons. RESULTS Quantitative and qualitative data suggested that the rotation increased military residents' knowledge, attitudes, and comfort level with HPM. Quantitative analysis of test scores indicated improvements from pre- to post-tests in each of five areas of learning. Qualitative data indicated the rotation created a greater appreciation for the overall importance of HPM and increased understanding of eligibility and methods for pain and symptom management. CONCLUSIONS A one-week community hospice rotation for medical military residents impacts participant's knowledge of and attitudes toward HPM.
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Affiliation(s)
- Krista L Harrison
- 1 Division of Geriatrics, School of Medicine, University of California , San Francisco, California
| | - Jackelyn Y Boyden
- 2 School of Nursing, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Virginia B Kalish
- 3 Department of Family Medicine, Fort Belvoir Community Hospital , Fort Belvoir, Virginia
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Yamamoto R, Kizawa Y, Nakazawa Y, Ohde S, Tetsumi S, Miyashita M. Outcome evaluation of the Palliative care Emphasis program on symptom management and Assessment for Continuous Medical Education: nationwide physician education project for primary palliative care in Japan. J Palliat Med 2015; 18:45-9. [PMID: 25495030 DOI: 10.1089/jpm.2014.0122] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE Palliative care is an essential part of medicine, but most physicians have had no formal opportunity to acquire basic skills in palliative care. In Japan, the Palliative care Emphasis program on symptom management and Assessment for Continuous Medical Education (PEACE) was launched to provide formal primary palliative care education for all physicians engaged in cancer care. This study sought to determine whether PEACE could improve physicians' knowledge of, practices in, and difficulties with palliative care. METHODS In 2011, we conducted questionnaire-based surveys before, just after, and 2 months after completion of the PEACE program in physicians participating in the program at each of 15 designated cancer hospitals in Japan. Knowledge was measured using the palliative care knowledge questionnaire for PEACE (PEACE-Q). Practices and difficulties were evaluated using the Palliative Care self-reported Practice Scale (PCPS) and the Palliative Care Difficulties Scale (PCDS), respectively. RESULTS Among 223 physicians participating in the program, 85 (38%) answered the follow-up survey. Significant improvements were noted on the PEACE-Q compared with baseline immediately after completion of the program, and this progress was maintained at 2 months (21.7 ± 5.56 versus 29.5 ± 2.10 versus 28.7 ± 3.28, respectively; p < 0.0001). Similarly, significant improvements were noted for total scores on both the PCPS and the PCDS at 2 months after completion of the program (62.1 ± 13.9 versus 69.6 ± 9.94 [p < 0.0001] for the PCPS; 44.4 ± 9.96 versus 39.4 ± 10.7 [p < 0.0001] for the PCDS). CONCLUSIONS The PEACE education program improved physicians' knowledge of, practices in, and difficulties with palliative care.
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Affiliation(s)
- Ryo Yamamoto
- 1 Department of Palliative Medicine, Saku Central Hospital Advanced Care Center , Nagano, Japan
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Bogetz JF, Rassbach CE, Bereknyei S, Mendoza FS, Sanders LM, Braddock CH. Training health care professionals for 21st-century practice: a systematic review of educational interventions on chronic care. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:1561-1572. [PMID: 26039140 DOI: 10.1097/acm.0000000000000773] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To systematically review the evidence for high-quality and effective educational strategies to train health care professionals across the education continuum on chronic disease care. METHOD A search of English-language publications and conference proceedings was performed in November 2013 and updated in April 2014. Studies that evaluated a newly developed curriculum targeting chronic disease care with learner outcomes were included. Two primary reviewers and one adjudicating reviewer evaluated the studies and assessed their quality using the validated Medical Education Research Study Quality Instrument (MERSQI). Studies were also mapped onto elements of Wagner's chronic care model (CCM) to evaluate their use of established evidence-based models for chronic care delivery. Miller's classification of clinical competence was used to assess the quality of learner achievements for each educational intervention. RESULTS A total of 672 articles were found for this review. Twenty-two met criteria for data extraction. The majority of studies were of moderate quality according to MERSQI scoring. Only three studies reported both learner and patient outcomes. The highest-quality studies incorporated more elements of Wagner's CCM and showed high-level learner competence according to Miller's classification. Successful interventions redesigned health care delivery systems to include team-based care, emphasized training of health care professionals on patient self-management, and included learner-based quality improvement initiatives. CONCLUSIONS The growing number of children and adults with chronic disease necessitates improved educational interventions for health care professionals that involve evidence-based models for restructuring chronic care delivery, aim for high-level learner behavioral outcomes, and evolve through quality improvement initiatives.
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Affiliation(s)
- Jori F Bogetz
- J.F. Bogetz is postdoctoral fellow and clinical instructor, Division of General Pediatrics, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California. C.E. Rassbach is associate residency program director, pediatric hospitalist, and clinical assistant professor, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California. S. Bereknyei is a research scholar, Stanford Center for Medical Education Research and Innovation (SCeMERI), Stanford University School of Medicine, Palo Alto, California. F.S. Mendoza is professor of pediatrics and chief, Division of General Pediatrics, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California. L.M. Sanders is associate professor of pediatrics, Division of General Pediatrics, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California. C.H. Braddock III is professor of medicine and vice dean for education, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California
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Kizawa Y, Morita T, Miyashita M, Shinjo T, Yamagishi A, Suzuki S, Kinoshita H, Shirahige Y, Yamaguchi T, Eguchi K. Improvements in Physicians' Knowledge, Difficulties, and Self-Reported Practice After a Regional Palliative Care Program. J Pain Symptom Manage 2015; 50:232-40. [PMID: 25847849 DOI: 10.1016/j.jpainsymman.2015.02.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 02/12/2015] [Accepted: 02/19/2015] [Indexed: 10/23/2022]
Abstract
CONTEXT Although several studies have explored the effects of regional palliative care programs, no studies have investigated the changes in physician-related outcomes. OBJECTIVES The primary aims of this study were to: (1) clarify the changes in knowledge, difficulties, and self-reported practice of physicians before and after the intervention, (2) explore the potential associations between the level of physicians' participation in the program and outcomes, and (3) identify the reasons and characteristics of physicians who did not participate in the program. METHODS As a part of the regional palliative care intervention trial, questionnaires were sent to physicians recruited consecutively to obtain a representative sample of each region. Physician-reported knowledge, difficulty of palliative care, and self-perceived practice were measured using the Palliative Care Knowledge Test, Palliative Care Difficulty Scale, and Palliative Care Self-Reported Practice Scale (PCPS), respectively. The level of their involvement in the program and reason for non-participation were ascertained from self-reported questionnaires. RESULTS The number of eligible physicians identified was 1870 in pre-intervention and 1763 in post-intervention surveys, and we obtained 911 and 706 responses. Total scores of the Palliative Care Knowledge Test, PCPS, and PCPS were significantly improved after the intervention, with effect sizes of 0.30, 0.52, and 0.17, respectively. Physicians who participated in workshops more frequently were significantly more likely to have better knowledge, less difficulties, and better self-reported practice. CONCLUSION After the regional palliative care program, there were marked improvements in physicians' knowledge and difficulties. These improvements were associated with the level of physicians' participation in the program.
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Affiliation(s)
- Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Mitsunori Miyashita
- Division of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | | | - Akemi Yamagishi
- Department of Community Health Care, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Satoshi Suzuki
- Department of Surgery, Tsuruoka Municipal Shonai Hospital, Tsuruoka, Yamagata, Japan
| | - Hiroya Kinoshita
- Department of Palliative Medicine, National Cancer Center Hospital, East, Kashiwa, Chiba, Japan
| | | | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kenji Eguchi
- Division of Medical Oncology, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan
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Feuz C, Rosewall T, Willis S. Radiation Therapy Students' Knowledge, Attitudes, and Beliefs about Palliative and End-of-Life Care for Cancer Patients. J Med Imaging Radiat Sci 2015; 46:271-279. [PMID: 31052133 DOI: 10.1016/j.jmir.2015.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 05/26/2015] [Accepted: 06/01/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND PURPOSE Although radiation therapy students are highly interested in providing palliative and end-of-life care (PEOLC), students often lack understanding of what palliative care is and express a lack of confidence when interacting with palliative patients. This study examined radiation therapy students' existing knowledge, attitudes, and beliefs toward PEOLC for cancer patients and how professional and personal experiences influenced those factors. METHODS This study used a cross-sectional online questionnaire. After informed consent, data were collected from a sample of students in an undergraduate radiation therapy program in Canada. Questions were both quantitative and qualitative in nature. Responses were comprised of Likert scales and true or false responses, a case study-based vignette and several short open-ended questions. RESULTS Sixty-one students completed the questionnaire; the response rate was 42%. Responses indicate students had an incomplete understanding of PEOLC principles despite reporting positive views and interest in the topic. Professional and personal experiences improved students' knowledge regarding the role of PEOLC and attitudes and beliefs became more positive with increased real-life experiences. CONCLUSIONS Experiential learning influences students' knowledge, attitudes, and beliefs about PEOLC. To better prepare students for their future professional roles, it is necessary for radiation therapy undergraduate programs to include PEOLC educational initiatives in its curricula. These initiatives should emphasize holistic care to prepare students to be competent radiation therapists who can address patients' complex PEOLC needs.
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Affiliation(s)
- Carina Feuz
- Radiation Therapy Department, Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada; Department of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK.
| | - Tara Rosewall
- Radiation Therapy Department, Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Susan Willis
- Department of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
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Wu KL, Friderici J, Goff SL. The impact of a palliative care team on residents' experiences and comfort levels with pediatric palliative care. J Palliat Med 2014; 17:80-4. [PMID: 24410421 DOI: 10.1089/jpm.2013.0227] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND 8,600 children are eligible for palliative care services each day in the US, yet many pediatric residents and pediatricians do not feel comfortable providing palliative/end of life care. OBJECTIVE To evaluate the impact of a palliative care team (PCT) on pediatric and internal medicine/pediatric (IM/Peds) residents knowledge, comfort level and experience providing pediatric palliative care (PPC). DESIGN Electronic 32-item questionnaire. SUBJECTS Pediatric and IM/Peds residents at ACGME accredited programs during the 2011-2012 academic year. MEASUREMENTS Residents' PPC training, knowledge, comfort levels and experiences. RESULTS Nearly two-thirds of 294 respondents (63.6%; 95% CI: 58.2, 69.1) selected a description of PPC that describes palliative care as starting at the time of diagnosis regardless of treatment goals. Participants who reported the presence of a PCT at their institution selected this accurate description of PPC more often than those who did not report the presence of a PCT (72.3% vs. 53.3%; p<0.001, Fisher's Exact Test). Overall, 55.3% (95% CI: 49.2, 61.3) were comfortable providing PPC. Reporting the presence of a PCT was also associated with more comfort in providing PPC (p<0.01). CONCLUSIONS Reported presence of a PCT may be associated with greater resident comfort in providing PPC and a more accurate understanding of PPC. There remains ample opportunity to educate pediatric and IM/Peds residents in PPC.
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Affiliation(s)
- Kelly L Wu
- Baystate Medical Center , Springfield, Massachusetts
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Nagamatsu Y, Natori Y, Yanai H, Horiuchi S. Impact of a nursing education program about caring for patients in Japan with malignant pleural mesothelioma on nurses' knowledge, difficulties and attitude: a randomized control trial. NURSE EDUCATION TODAY 2014; 34:1087-1093. [PMID: 24630905 DOI: 10.1016/j.nedt.2014.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 01/28/2014] [Accepted: 02/17/2014] [Indexed: 06/03/2023]
Abstract
PURPOSE In Japan nursing care lags behind the growing population of patients with malignant pleural mesothelioma. This study evaluated an educational program for nurses about caring for patients with malignant pleural mesothelioma in Japan. METHOD In this randomized controlled study relative to care for malignant pleural mesothelioma, Knowledge, Difficulties and Attitude were measured at baseline, at post-test and at follow-up one month later. The two-day program with a half-day follow-up program included lectures, group work, role-playing and group discussion. 188 participants were randomly assigned to the intervention group (program, n=96) and control group (n=92; self-study by a similar content handbook). At baseline the groups showed no statistical differences in Knowledge (p=0.921), Difficulty (p=0.458) and Attitude (p=0.922). Completing the study were 177 participants yielding 88 in the intervention group and 89 in the control group. Human rights and privacy of participants were protected. RESULTS The Knowledge score was significantly higher in the intervention post-test (t=14.03, p=0.000) and follow-up test (t=8.98, p=0.000). Difficulty score was significantly lower in the intervention at post-test (t=-3.41, p=0.001) and follow-up test (t=-3.70, p=0.000). The Attitude score was significantly higher in the intervention post-test (t=7.11, p=0.000) and follow-up test (t=4.54, p=0.000). The two-way analysis of variance with repeated measures on time showed an interaction between time and group; the subsequent simple main effect test found significant differences (p=0.000-0.001) between groups for after-program and at follow-up and a significant difference (p=0.000) in time only within the intervention group. CONCLUSION The educational program was effective in improving the nurses' knowledge and attitude toward malignant pleural mesothelioma care and decreasing the difficulty in MPM care, therefore this program has potential for nurses' in-service education throughout Japan.
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Wittenberg-Lyles E, Goldsmith J, Ferrell B, Burchett M. Assessment of an Interprofessional Online Curriculum for Palliative Care Communication Training. J Palliat Med 2014; 17:400-6. [DOI: 10.1089/jpm.2013.0270] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Elaine Wittenberg-Lyles
- Division of Nursing Research and Education, City of Hope National Medical Center, Duarte, California
| | - Joy Goldsmith
- Department of Communication, University of Memphis, Memphis, Tennessee
| | - Betty Ferrell
- Division of Nursing Research and Education, City of Hope National Medical Center, Duarte, California
| | - Molly Burchett
- Department of Communication, University of Kentucky, Lexington, Kentucky
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Corcoran AM, Lysaght S, Lamarra D, Ersek M. Pilot test of a three-station palliative care observed structured clinical examination for multidisciplinary trainees. J Nurs Educ 2013; 52:294-8. [PMID: 23550548 DOI: 10.3928/01484834-20130328-02] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 12/19/2012] [Indexed: 11/20/2022]
Abstract
Developing effective communication and symptom assessment skills is an important component of palliative care training for advance practice nurses (APNs) and other health care providers. The purpose of this project was to develop and pilot test a three-station palliative care Observed Structured Clinical Examination (OSCE) for APN students and physician fellows. Three stations included discussing goals of care, breaking bad news, and assessing delirium. Measures included the Interpersonal Skills Tool, Station Checklists, the OSCE Evaluation Tool, and a focus group to solicit learners' perspectives about the experience. Findings showed that learners evaluated the exercise as appropriate for their level of training and that standardized patients were convincing and provided helpful feedback. Learner self-evaluation means were significantly lower than those of standardized patient or faculty, and faculty raters demonstrated low interrater reliability. Initial evaluation suggests a three-station palliative care OSCE exercise is effective for multidisciplinary learners, although additional refinement is necessary.
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Affiliation(s)
- Amy M Corcoran
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Gallagher K, Cass H, Black R, Norridge M. A training needs analysis of neonatal and paediatric health-care staff in a tertiary children's hospital. Int J Palliat Nurs 2012; 18:197-201. [PMID: 22584391 DOI: 10.12968/ijpn.2012.18.4.197] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Despite clinical advances in neonatal and paediatric palliative care, there is limited educational provision to underpin practice. To develop appropriate educational content, the needs of staff working in this area must be identified. AIM To explore the educational needs of staff working with families with palliative or end-of-life care requirements. METHODS A training needs analysis (TNA) explored the perceived knowledge, confidence, and support of neonatal and paediatric health professionals in a tertiary children's hospital in London. RESULTS An online Likert scale TNA was completed by 111 participants. The results indicated that the staff did not feel educationally prepared in their working areas, despite having regular contact with families with palliative or end-of-life care issues. DISCUSSION Understanding the educational needs of staff can underpin the development of appropriate educational interventions. These modules require evaluation to determine their impact on health professionals' knowledge and confidence.
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Affiliation(s)
- Katie Gallagher
- Florence Nightingale School of Nursing and Midwifery, Kings College, London, UK.
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Weil J, Gold M, McIver S, Rotstein L, Philip J. Australian resident doctors want more palliative medicine education: a survey of attitudes and perceived needs. Intern Med J 2012; 42:828-30. [DOI: 10.1111/j.1445-5994.2012.02824.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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