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Murphy R, Barnes CJ, Enright PD, Gratton V, Bush SH. Mapping an undergraduate medical education curriculum against national and international palliative care reference learning objectives. BMC MEDICAL EDUCATION 2024; 24:105. [PMID: 38303063 PMCID: PMC10836050 DOI: 10.1186/s12909-024-05082-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/22/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND The teaching of palliative care competencies is an essential component of undergraduate medical education. There is significant variance in the palliative care content delivered in undergraduate medical curricula, revealing the utility of reference standards to guide curricular development and assessment. To evaluate our university's undergraduate palliative care teaching, we undertook a curriculum mapping exercise, comparing official learning objectives to the national Educating Future Physicians in Palliative and End-of-Life Care (EFPPEC) and the international Palliative Education Assessment Tool (PEAT) reference objectives. METHODS Multiple assessors independently compared our university's UGME learning objectives with EFPPEC and PEAT reference objectives to determine the degree-of-coverage. Visual curriculum maps were created to depict in which part of the curriculum each objective is delivered and by which medical specialty. RESULTS Of 122 EFPPEC objectives, 55 (45.1%) were covered fully, 42 (34.4%) were covered partially, and 25 (20.5%) were not covered by university objectives. Of 89 PEAT objectives, 40 (44.9%) were covered fully, 35 (39.3%) were covered partially, and 14 (15.7%) were not covered by university objectives. CONCLUSIONS The majority of EFPPEC and PEAT reference objectives are fully or partially covered in our university's undergraduate medical curriculum. Our approach could serve as a guide for others who endeavour to review their universities' specialty-specific medical education against reference objectives. Future curriculum development should target the elimination of identified gaps and evaluate the attainment of palliative care competencies by medical learners.
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Affiliation(s)
- Rebekah Murphy
- Department of Medicine, Division of Palliative Care, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada.
- Department of Palliative Care, Bruyère Continuing Care, Saint-Vincent Hospital, 60 Cambridge St N, Ottawa, ON, K1R 7A5, Canada.
- Department of Medicine, Queensway Carleton Hospital, 3045 Baseline Rd, Ottawa, ON, K2H 8P4, Canada.
| | - Christopher J Barnes
- Department of Medicine, Division of Palliative Care, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada
- Department of Palliative Care, Bruyère Continuing Care, Saint-Vincent Hospital, 60 Cambridge St N, Ottawa, ON, K1R 7A5, Canada
| | - Paula D Enright
- Department of Medicine, Division of Palliative Care, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada
- Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada
| | - Valerie Gratton
- Department of Medicine, Division of Palliative Care, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada
- Institut du Savoir Montfort, 713 Montréal Rd, Ottawa, ON, K1K 0T2, Canada
- Department of Family Medicine, Montfort Hospital, 713 Montréal Rd, Ottawa, ON, K1K 0T2, Canada
| | - Shirley H Bush
- Department of Medicine, Division of Palliative Care, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada
- Department of Palliative Care, Bruyère Continuing Care, Saint-Vincent Hospital, 60 Cambridge St N, Ottawa, ON, K1R 7A5, Canada
- Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada
- Bruyère Research Institute, 43 Bruyère St, Ottawa, ON, K1N 5C8, Canada
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Gerlach C, Mai SS, Schmidtmann I, Weber M. Palliative care in undergraduate medical education - consolidation of the learning contents of palliative care in the final academic year. GMS JOURNAL FOR MEDICAL EDUCATION 2021; 38:Doc103. [PMID: 34651061 PMCID: PMC8493850 DOI: 10.3205/zma001499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 04/26/2021] [Accepted: 05/17/2021] [Indexed: 06/13/2023]
Abstract
Background: Demographic change and the medical imperative to accompany patients at all times and also in the case of illness leading to death require good basic knowledge of palliative care in large parts of the medical profession. Palliative care has been introduced into undergraduate medical education as a compulsory subject: "interdisciplinary subject 13 palliative care" (Q13). While course concepts for Q13 have already been positively evaluated, assessment of the consolidation and practical relevance of the knowledge taught is lacking. Methods: Assessment of the consolidation of the learning content from Q13 after the practical year (the "practical year" is the sixth and final year of undergraduate medical education in Germany) by means of a survey with a proven questionnaire and integrated qualitative free-text analysis of a cohort of medical students (n=176) who had already participated in an evaluation before and after Q13. Results: The response rate was 96% after Q13 and 45% after the practical year (PY). Teaching was predominantly perceived as more helpful than the PY (p<0.001). Compared to the status after Q13, students rated themselves as less competent after the PY in all areas surveyed, including drug-based pain therapy (p=0.0386). The certainty in informing patients about the incurability of the disease also decreased significantly after the PY (p=0.0117), although the preparation in Q13 was positively highlighted. Conclusion: The knowledge acquired in Q13 could not be anchored in the PY. On the contrary, after initial practical experiences, the students found it challenging to conduct conversations in cases of serious illness and to deal with their own uncertainty in the care of seriously ill patients. Structural factors regarding palliative care in the PY, as well as intrinsic motives of students, such as prior knowledge or motivation to learn, should be analyzed to identify ways to close the gap between theoretical and practical training in general palliative care. To generate samples that are sufficiently representative, future studies on teaching should be easily accessible to students and consider attractive forms of evaluation including electronic methods and social media.
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Affiliation(s)
- Christina Gerlach
- Johannes Gutenberg University Mainz, University Medical Center, III. Med. Clinic & Polyclinic, Hematology, Oncology und Pneumology, Interdisciplinary Department of Palliative Care, Mainz, Germany
- Heidelberg University Hospital, Department of Palliative Care, Heidelberg, Germany
| | - Sandra Stephanie Mai
- Johannes Gutenberg University Mainz, University Medical Center, III. Med. Clinic & Polyclinic, Hematology, Oncology und Pneumology, Interdisciplinary Department of Palliative Care, Mainz, Germany
| | - Irene Schmidtmann
- Johannes Gutenberg University Mainz, University Medical Center, Institute for Medical Biometry, Epidemiology and Informatics, Mainz, Germany
| | - Martin Weber
- Johannes Gutenberg University Mainz, University Medical Center, III. Med. Clinic & Polyclinic, Hematology, Oncology und Pneumology, Interdisciplinary Department of Palliative Care, Mainz, Germany
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Preston N, Hasselaar J, Hughes S, Kaley A, Linge-Dahl L, Radvanyi I, Tubman P, Van Beek K, Varey S, Payne S. Disseminating research findings using a massive online open course for maximising impact and developing recommendations for practice. BMC Palliat Care 2020; 19:54. [PMID: 32321491 PMCID: PMC7178937 DOI: 10.1186/s12904-020-00564-7] [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: 08/12/2019] [Accepted: 04/17/2020] [Indexed: 12/05/2022] Open
Abstract
Background Developing recommendations for how we deliver healthcare is often left to leading experts in a field. Findings from the Integrated Palliative Care in cancer and chronic conditions (InSup-C) study, which aimed to identify best practice in integrated palliative care in cancer, chronic obstructive pulmonary disease (COPD) and heart failure, led to recommendations developed through an expert consultation process. We also wanted to develop these recommendations further with participants who were largely clinicians and members of the public. Methods Results from the InSup-C study were disseminated through a three-week massive open online course (MOOC) which ran in 2016, 2017 and 2019. The first course helped develop the final recommendations, which were ranked by MOOC participants in the subsequent courses. MOOC participants were predominantly clinicians, but also academics and members of the public. They rated how important each recommendation was on a 9 point scale (9 most important). Descriptive statistics were used to analyse the ratings. The results were compared to findings from the consultation. Results Five hundred fifteen completed the last part of the course where the recommendations were ranked, of which 195 (38%) completed the ratings. The top recommendations related to: need to expand palliative care to non-malignant conditions; palliative care needs to include different dimensions of care including physical, psychological and spiritual; policies and regulations assessments should be made regularly; palliative care integration should be mandatory; and there should be greater availability of medicines. These differed compared to the top ranked recommendations by the consultation panel in relation to the importance of leadership and policy making. This may indicate that clinicians are more focused on daily care rather than the (inter) national agenda. Conclusions Whilst both sets of recommendations are important, our study shows that we need to include the views of clinicians and the public rather than rely upon leading expert opinion alone. To keep recommendations fresh we need both the input of clinicians, the public and experts. When disseminating findings, MOOCs offer a useful way to gain greater reach with clinicians and the public, and importantly could be a vehicle to validate recommendations made by leading expert panels.
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Affiliation(s)
- Nancy Preston
- International Observatory on end of Life Care, Lancaster University, Lancaster, UK.
| | - Jeroen Hasselaar
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sean Hughes
- International Observatory on end of Life Care, Lancaster University, Lancaster, UK
| | | | - Lisa Linge-Dahl
- Department of Palliative Care, University Hospital Bonn, Bonn, Germany
| | | | | | - Karen Van Beek
- Department of Radiation-Oncology and Palliative Medicine, University Hospital Gasthuisberg, Leuven, Belgium
| | - Sandra Varey
- International Observatory on end of Life Care, Lancaster University, Lancaster, UK
| | - Sheila Payne
- International Observatory on end of Life Care, Lancaster University, Lancaster, UK
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Abstract
BACKGROUND Building palliative care capacity among all healthcare practitioners caring for patients with chronic illnesses, who do not work in specialist palliative care services (non-specialist palliative care), is fundamental in providing more responsive and sustainable palliative care. Varying terminology such as 'generalist', 'basic' and 'a palliative approach' are used to describe this care but do not necessarily mean the same thing. Internationally, there are also variations between levels of palliative care which means that non-specialist palliative care may be applied inconsistently in practice because of this. Thus, a systematic exploration of the concept of non-specialist palliative care is warranted. AIM To advance conceptual, theoretical and operational understandings of and clarity around the concept of non-specialist palliative care. DESIGN The principle-based method of concept analysis, from the perspective of four overarching principles, such as epistemological, pragmatic, logical and linguistic, were used to analyse non-specialist palliative care. DATA SOURCES The databases of CINAHL, PubMed, PsycINFO, The Cochrane Library and Embase were searched. Additional searches of grey literature databases, key text books, national palliative care policies and websites of chronic illness and palliative care organisations were also undertaken. CONCLUSION Essential attributes of non-specialist palliative care were identified but were generally poorly measured and understood in practice. This concept is strongly associated with quality of life, holism and patient-centred care, and there was blurring of roles and boundaries particularly with specialist palliative care. Non-specialist palliative care is conceptually immature, presenting a challenge for healthcare practitioners on how this clinical care may be planned, delivered and measured.
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Affiliation(s)
- Mary Nevin
- School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, Ireland
| | - Valerie Smith
- School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, Ireland
| | - Geralyn Hynes
- School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, Ireland
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Arias N, Garralda E, De Lima L, Rhee JY, Centeno C. Global Palliative Care and Cross-National Comparison: How Is Palliative Care Development Assessed? J Palliat Med 2019; 22:580-590. [DOI: 10.1089/jpm.2018.0510] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Natalia Arias
- ATLANTES Research Program, Institute for Culture and Society, University of Navarra, Pamplona, Spain
| | - Eduardo Garralda
- ATLANTES Research Program, Institute for Culture and Society, University of Navarra, Pamplona, Spain
- IdiSNA (Instituto de Investigación Sanitaria de Navarra/Institute of Health Research of Navarra), Pamplona, Spain
| | - Liliana De Lima
- International Association for Hospice and Palliative Care, Houston, Texas
| | - John Y. Rhee
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Carlos Centeno
- ATLANTES Research Program, Institute for Culture and Society, University of Navarra, Pamplona, Spain
- IdiSNA (Instituto de Investigación Sanitaria de Navarra/Institute of Health Research of Navarra), Pamplona, Spain
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Payne S, Hughes S, Wilkinson J, Hasselaar J, Preston N. Recommendations on priorities for integrated palliative care: transparent expert consultation with international leaders for the InSuP-C project. BMC Palliat Care 2019; 18:32. [PMID: 30943951 PMCID: PMC6448308 DOI: 10.1186/s12904-019-0418-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 03/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The World Health Organisation (WHO) endorses integrated palliative care which has a significant impact on quality of life and satisfaction with care. Effective integration between hospices, palliative care services, hospitals and primary care services are required to support patients with palliative care needs. Studies have indicated that little is known about which aspects are regarded as most important and should be priorities for international implementation. The Integrated Palliative Care in cancer and chronic conditions (InSup-C) project, aimed to investigate integrated practices in Europe and to formulate requirements for effective palliative care integration. It aimed to develop recommendations, and to agree priorities, for integrated palliative care linked to the InSuP-C project. METHODS Transparent expert consultation was adopted at the approach used. Data were collected in two phases: 1) international transparent expert consultation using face-to-face roundtable discussions at a one day workshop in Brussels, and 2) via subsequent online cross-sectional survey where items were rated to indicate degree of agreement on their importance and ranked to indicate priority for implementation. Workshop discussions used content analysis to develop a list of 23 recommendations, which formed the survey questionnaire. Survey analysis used descriptive statistics and qualitative content analysis of open responses. RESULTS Thirty-six international experts in palliative care and cancer care, including senior clinicians, researchers, leaders of relevant international organisations and funders, were invited to a face-to-face workshop. Data were collected from 33 (19 men, 14 women), 3 declined. They mostly came from European countries (31), USA (1) and Australia (1). Twenty one of them also completed the subsequent online survey (response rate 63%). We generated 23 written statements that were grouped into the organisational constructs: macro (10), meso (6) and micro (7) levels of integration of palliative care. Highest priority recommendations refer to education, leadership and policy-making, medium priority recommendations focused on funding and relationship-building, and lower priority recommendations related to improving systems and infrastructure. CONCLUSIONS Our findings suggest that amongst a group of international experts there was overall good agreement on the importance of recommendations for integrated palliative care. Understanding expert's priorities is important and can guide practice, policymaking and future research.
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Affiliation(s)
- Sheila Payne
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, LA1 4YG, UK.
| | - Sean Hughes
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, LA1 4YG, UK
| | - Joann Wilkinson
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, LA1 4YG, UK
| | - Jeroen Hasselaar
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nancy Preston
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, LA1 4YG, UK
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Soklaridis S, Ferguson G, Bonato S, Saikaly R, Mosher PJ. Being there: protocol for a scoping review of the medical education literature on grief support training for medical professionals. BMJ Open 2019; 8:e022778. [PMID: 30798287 PMCID: PMC6278787 DOI: 10.1136/bmjopen-2018-022778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Medical trainees and professionals do not perceive that they are adequately taught the skills to address issues of grief with their patients. Atypical grief responses can prolong suffering, interrupt normal activities and lead to increased morbidity and mortality. Grief training can help physicians cope with feelings about and responses to suffering, loss and death in a way that improves both physician and patient/family wellness. This scoping review will describe the current landscape of grief training worldwide in medical school and residency and in continuing professional development in the disciplines of paediatrics, family medicine and psychiatry. The ultimate goal is to help physicians support patients experiencing grief. METHODS AND ANALYSIS The study design has been adapted from Arksey and O'Malley's review methodology. We will work with an information specialist who will run searches in six multidisciplinary databases. To supplement the search, we will scan the reference lists of included studies. Two levels of screening will take place: a title and abstract review for articles that fit predefined criteria and a full-text review of articles that meet those criteria. To be included in the review, articles must report on grief training for medical residents and professionals in the fields of paediatrics, family medicine and psychiatry. Two investigators will review each article and extract data. ETHICS AND DISSEMINATION Research ethics approval is not required for this review. We plan to share the findings through national and international medical education conferences and to publish the results in a peer-reviewed academic journal. We have the support of several directors of medical education at our institution who are interested in the growing focus on humanism in medical education as a way of decreasing burnout among medical students, residents and faculty.
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Affiliation(s)
- Sophie Soklaridis
- Office of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Departments of Psychiatry and Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Cross-Appointed Scientist, Wilson Centre, University Health Network and Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Genevieve Ferguson
- Office of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sarah Bonato
- Office of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Riley Saikaly
- Office of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Pamela J Mosher
- Office of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Departments of Psychiatry and Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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Denney-Koelsch EM, Horowitz R, Quill T, Baldwin CD. An Integrated, Developmental Four-Year Medical School Curriculum in Palliative Care: A Longitudinal Content Evaluation Based on National Competency Standards. J Palliat Med 2018; 21:1221-1233. [PMID: 29768072 DOI: 10.1089/jpm.2017.0371] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND While palliative care (PC) competencies for medical school graduates have been defined, the lack of established curriculum models and assessment tools hampers curricular evaluation. OBJECTIVE To describe the scope and content of the University of Rochester's longitudinal, integrated four-year PC curriculum after 17 years of implementation, review student evaluative responses, and compare the curriculum to national competency standards. DESIGN AND SETTING Combining and reorganizing a published PC curriculum assessment tool and a list of medical school PC competencies, we created a novel nine-topic framework to assess the content coverage of our curriculum. We queried our electronic medical school curriculum database and surveyed course and clerkship directors, as well as PC, pain, ethics, and humanities faculty, to locate where and when PC topics are taught and to collate student responses to these experiences. RESULTS We present a comprehensive list of PC curricular activities over a four-year medical school experience. The curriculum covers all nine PC topics longitudinally in multiple formats. Five in-depth activities cover multiple PC topics in a format that integrates biological, psychological, and social dimensions; these activities have survived and evolved over 17 years in our setting. A majority of year 3 University of Rochester students feel "well" or "extremely well" trained in PC. CONCLUSIONS Our four-year PC curriculum provides robust and developmentally appropriate training that addresses all nine evidence-based core topics for PC education. Medical student feedback and their Association of American Medical Colleges (AAMC) survey responses suggest that they find their PC learning experiences rewarding. This curriculum could serve as a model for other schools.
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Affiliation(s)
- Erin M Denney-Koelsch
- 1 Division of Palliative Care, University of Rochester Medical Center , Rochester, New York
| | - Robert Horowitz
- 1 Division of Palliative Care, University of Rochester Medical Center , Rochester, New York
| | - Timothy Quill
- 1 Division of Palliative Care, University of Rochester Medical Center , Rochester, New York
| | - Constance D Baldwin
- 2 Department of Pediatrics, University of Rochester Medical Center , Rochester, New York
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Schulz-Quach C, Wenzel-Meyburg U, Fetz K. Can elearning be used to teach palliative care? - medical students' acceptance, knowledge, and self-estimation of competence in palliative care after elearning. BMC MEDICAL EDUCATION 2018; 18:82. [PMID: 29699593 PMCID: PMC5921412 DOI: 10.1186/s12909-018-1186-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 04/09/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Undergraduate palliative care education (UPCE) was mandatorily incorporated in medical education in Germany in 2009. Implementation of the new cross-sectional examination subject of palliative care (QB13) continues to be a major challenge for medical schools. It is clear that there is a need among students for more UPCE. On the other hand, there is a lack of teaching resources and patient availabilities for the practical lessons. Digital media and elearning might be one solution to this problem. The primary objective of this study is to evaluate the elearning course Palliative Care Basics, with regard to students' acceptance of this teaching method and their performance in the written examination on the topic of palliative care. In addition, students' self-estimation in competence in palliative care was assessed. METHODS To investigate students' acceptance of the elearning course Palliative Care Basics, we conducted a cross-sectional study that is appropriate for proof-of-concept evaluation. The sample consisted of three cohorts of medical students of Heinrich Heine University Dusseldorf (N = 670). The acceptance of the elearning approach was investigated by means of the standard evaluation of Heinrich Heine University. The effect of elearning on students' self-estimation in palliative care competencies was measured by means of the German revised version of the Program in Palliative Care Education and Practice Questionnaire (PCEP-GR). RESULTS The elearning course Palliative Care Basics was well-received by medical students. The data yielded no significant effects of the elearning course on students' self-estimation in palliative care competencies. There was a trend of the elearning course having a positive effect on the mark in written exam. CONCLUSIONS Elearning is a promising approach in UPCE and well-accepted by medical students. It may be able to increase students' knowledge in palliative care. However, it is likely that there are other approaches needed to change students' self-estimation in palliative care competencies. It seems plausible that experience-based learning and encounters with dying patients and their relatives are required to increases students' self-estimation in palliative care competencies. TRIAL REGISTRATION Heinrich Heine University Medical School Clinical Trial Registry No. 4876 (date of approval 26.11.2014).
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Affiliation(s)
- Christian Schulz-Quach
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Department of Psychological Medicine, King’s College, London, UK
- St Christopher’s Hospice London, Dusseldorf, UK
| | - Ursula Wenzel-Meyburg
- Interdisciplinary Centre for Palliative Medicine, Medical Faculty, Heinrich Heine University Dusseldorf, Dusseldorf, Germany
| | - Katharina Fetz
- Chair of Research Methodology and Statistics in Psychology, Department of Psychology & Psychotherapy, Faculty of Health, Witten/Herdecke University, Witten, Germany
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Lehto JT, Hakkarainen K, Kellokumpu-Lehtinen PL, Saarto T. Undergraduate curriculum in palliative medicine at Tampere University increases students' knowledge. BMC Palliat Care 2017; 16:13. [PMID: 28122553 PMCID: PMC5264301 DOI: 10.1186/s12904-016-0182-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 12/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Education in palliative medicine (PM) at medical schools reveals wide variation despite the increasing importance of palliative care. Many universities present poor description of the benefits and detailed content of the total curriculum in PM. Using the recommendations of European Association for Palliative Care (EAPC) as a reference, we evaluated the content and outcomes of the curriculum in PM at the University of Tampere, Finland. METHODS We searched for a PM curriculum by examining the teaching offered by every specialty and compared it to EAPC recommendations. Students' knowledge was evaluated using a progress test over three consecutive years. RESULTS We found 53.5 teaching hours addressing PM issues, which exceeds the recommendation of the EAPC. Basics, symptom management, ethics, and communication skills were well established, while education in psychosocial/spiritual aspects, teamwork and self-reflection failed to reach the recommendations. Out of the maximum of 4.0, the progress test mean scores in PM among the third, fourth, fifth and sixth year students were 0.1 (SD 0.71), 0.69 (SD 1.28), 1.38 (SD 1.46) and 2.53 (SD 1.26), respectively (p < 0.001). This growing knowledge was associated with the timely increase in teaching provided through the PM discipline. In addition, the students who completed the optional PM course achieved better mean scores (2.66; SD 1.27) than the others (1.33; SD 1.43) (p < 0.001). CONCLUSIONS The curriculum in PM at the University of Tampere is integrated into the teaching of many disciplines and complied well with the EAPC recommendations. This education led to increasing knowledge in PM among medical students.
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Affiliation(s)
- Juho T Lehto
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland. .,Department of Oncology, Tampere University Hospital, Tampere, Finland. .,Department of Oncology, Palliative Care Unit, Tampere University Hospital, Teiskontie 35, Rbuilding, 33520, Tampere, Finland.
| | - Kati Hakkarainen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Pirkko-Liisa Kellokumpu-Lehtinen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Department of Oncology, Tampere University Hospital, Tampere, Finland
| | - Tiina Saarto
- Comprehensive Cancer Center and Faculty of Medicine, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
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Fitzpatrick D, Heah R, Patten S, Ward H. Palliative Care in Undergraduate Medical Education—How Far Have We Come? Am J Hosp Palliat Care 2016; 34:762-773. [DOI: 10.1177/1049909116659737] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose: There is an increasing demand for quality palliative care teaching within undergraduate medical education. Studies suggest that many junior doctors feel underprepared to perform end-of-life care. Previous systematic reviews on palliative care teaching within medical schools have identified significant variability and lack of consistency in teaching. This review aims to update the literature on the current status of palliative care teaching to undergraduates within medical schools. Method: A systematic review was undertaken on articles published from December 2001 to November 2015 on palliative care teaching for undergraduate medical students. In all, 650 abstract citations were obtained, of which 126 were relevant to the research questions. Thematic analysis was performed on remaining articles according to whether they discussed content and/or methodology of palliative care education, and data collated. Results: There is greater consistency in the content being delivered as part of end-of-life care education within medical schools. The most frequently taught topics include attitudes to death and dying, communication skills, and pain management. Pediatric care and religious/cultural issues are less frequently addressed. Teaching institutions are also utilising a broader range of teaching modalities. Conclusion: There is significant progress in palliative care education within medical schools. Ongoing challenges relate to correlating our current practice in medical education to professional recommendations and the expressed needs of junior doctors to practice competent end-of-life care.
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Affiliation(s)
- Danielle Fitzpatrick
- Adelaide Health Simulation and Skills Centre, The University of Adelaide, Adelaide, Australia
| | - Rebecca Heah
- Adelaide Health Simulation and Skills Centre, The University of Adelaide, Adelaide, Australia
| | - Simon Patten
- Adelaide Health Simulation and Skills Centre, The University of Adelaide, Adelaide, Australia
| | - Helena Ward
- Medicine Learning and Teaching Unit, The University of Adelaide, Adelaide, Australia
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Tse CS, Morrison LJ, Ellman MS. Preclinical Medical Students' Diverse Educational and Emotional Responses to a Required Hospice Experience. Am J Hosp Palliat Care 2016; 34:704-712. [PMID: 27235456 DOI: 10.1177/1049909116652574] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Physicians' lack of comfort and skill in communicating about hospice care results in deficits and delays in hospice referrals. Preclinical exposure to hospice may lay a foundation to improve medical students' knowledge and comfort with hospice care. OBJECTIVE To understand how preclinical medical student (MS)-2s respond both educationally and emotionally to a required hospice care experience (HCE). DESIGN Accompanied by hospice clinicians, MS-2s spent 3 hours seeing inpatient or home hospice patients followed by a 1-hour debriefing. Students submitted written reflections to e-mailed educational and emotional prompts. SETTING/PATIENTS Two hundred and two MS-2s from 2 academic cohorts completed the HCE at 1 of 2 hospice sites. MEASUREMENTS Written reflective responses were analyzed qualitatively, where salient themes extracted and responses were coded. RESULTS Ninety-two students submitted 175 responses to Prompt #1 (educational impact) and 85 students entered 85 responses to prompt #2 (emotional impact) of the HCE. Eleven themes were identified for prompt #1, most frequently focusing on hospice services and goals and hospice providers' attitudes and skills. Prompt #2 elicited a diverse spectrum of emotional responses, spanning positive and negative emotions. Most often, students reported "no specified emotional reaction," "sad/depressed," "difficult /challenging," "heartened/encouraged," and "mixed emotions." CONCLUSION In an HCE, preclinical students reported learning core aspects of hospice care and experiencing a broad spectrum of emotional responses. These findings may assist educators in the planning of HCEs for preclinical students, including debriefing sessions with skilled clinicians and opportunities for triggered reflection.
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Affiliation(s)
- Chung Sang Tse
- 1 Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Laura J Morrison
- 2 Yale Palliative Care Program, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Matthew S Ellman
- 3 Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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Ellman MS, Fortin AH, Putnam A, Bia M. Implementing and Evaluating a Four-Year Integrated End-of-Life Care Curriculum for Medical Students. TEACHING AND LEARNING IN MEDICINE 2016; 28:229-39. [PMID: 27064725 DOI: 10.1080/10401334.2016.1146601] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
PROBLEM Meeting the needs of patients with life-limiting and terminal illness requires effectively trained physicians in all specialties to provide skillful and compassionate care. Despite mandates for end-of-life (EoL) care education, graduating medical students do not consistently feel prepared to provide this care. INTERVENTION We have developed a longitudinal, integrated, and developmental 4-year curriculum in EoL care. The curriculum's purpose is to teach basic competencies in EoL care. A variety of teaching strategies emphasize experiential, skill-building activities with special attention to student self-reflection. In addition, we have incorporated interprofessional learning and education on the spiritual and cultural aspects of care. We created blended learning strategies combining interactive online modules with live workshops that promote flexibility, adaptability, and interprofessional learning opportunities. CONTEXT The curriculum was implemented and evaluated in the 4-year program of studies at Yale School of Medicine. OUTCOME A mixed-method evaluation of the curriculum included reviews of student written reflections and questionnaires, graduating student surveys, and demonstration of 4th-year students' competency in palliative care with an observed structured clinical examination (OSCE). These evaluations demonstrate significant improvements in students' self-reported preparedness in EoL care and perceptions of the adequacy in their instruction in EoL and palliative care, as well as competency in primary palliative care in a newly developed OSCE. LESSONS LEARNED A 4-year longitudinal integrated curriculum enhances students' skills and preparedness in important aspects of EoL care. As faculty resources, clinical sites, and curricular structure vary by institution, proven and adaptable educational strategies as described in this article may be useful to address the mandate to improve EoL care education. Teaching strategies and curricular components and design as just described can be adapted to other programs.
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Affiliation(s)
- Matthew S Ellman
- a Department of Medicine , Yale School of Medicine , New Haven , Connecticut , USA
| | - Auguste H Fortin
- a Department of Medicine , Yale School of Medicine , New Haven , Connecticut , USA
| | - Andrew Putnam
- a Department of Medicine , Yale School of Medicine , New Haven , Connecticut , USA
| | - Margaret Bia
- a Department of Medicine , Yale School of Medicine , New Haven , Connecticut , USA
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Pastrana T, Wenk R, De Lima L. Consensus-Based Palliative Care Competencies for Undergraduate Nurses and Physicians: A Demonstrative Process with Colombian Universities. J Palliat Med 2016; 19:76-82. [PMID: 26485612 PMCID: PMC4692128 DOI: 10.1089/jpm.2015.0202] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND A World Health Assembly (WHA) resolution adopted in 2014 strongly encourages member states to integrate palliative care (PC) in undergraduate training for health professionals. OBJECTIVE The study objective was to describe a consensus-based process workshop to develop PC competences for medical and nursing schools in Colombia and to present a summary of the findings. METHODS The workshop included 36 participants representing 16 medical and 6 nursing schools from 18 universities in Colombia. Participants were distributed in four thematic groups. Using the International Association for Hospice and Palliative Care (IAHPC) List of Essential Practices (LEP) as guidance, they were asked to discuss and define PC competencies at the undergraduate level. Participants provided feedback and approved each recommendation, and then were asked to complete an evaluation. RESULTS The resulting competences were separated into six categories: (1) Definition and Principles of PC, (2) Identification and Control of Symptoms, (3) End-of-Life Care, (4) Ethical and Legal Issues, (5) Psychosocial and Spiritual Issues, and (6) Teamwork. A comparative analysis revealed that treatment of several symptoms in the IAHPC LEP (pain, dyspnea, constipation, nausea, vomit, diarrhea, delirium, and insomnia) were included in the competencies. All of the IAHPC LEP related to psychological/emotional/spiritual care was included. The evaluation rate of return was 80%. The assessment was very positive: total score of 4.7/5.0; SD = 0.426), with 89% considering the workshop to be helpful. CONCLUSION The workshop provided an opportunity for individuals from different disciplines to discuss competencies and achieve consensus. The resulting competencies will be helpful in the development of PC curricula for physicians and nurses throughout schools in Colombia and other countries.
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Affiliation(s)
- Tania Pastrana
- Department of Palliative Medicine, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Roberto Wenk
- Fundacion FEMEBA (PAMP-FF), Argentina, San Nicolas, Argentina
| | - Liliana De Lima
- International Association for Hospice and Palliative Care, Houston, Texas
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Ilse B, Alt-Epping B, Kiesewetter I, Elsner F, Hildebrandt J, Laske A, Scherg A, Schiessl C. Undergraduate education in palliative medicine in Germany: a longitudinal perspective on curricular and infrastructural development. BMC MEDICAL EDUCATION 2015; 15:151. [PMID: 26383546 PMCID: PMC4574529 DOI: 10.1186/s12909-015-0439-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 09/11/2015] [Indexed: 05/27/2023]
Abstract
BACKGROUND In 2009, palliative medicine became an integrated and compulsory part of undergraduate training in Germany by legislation. After a transitional period, all medical faculties were required to provide adequate teaching with an according examination and certification procedure. In parallel, we conducted bi-annual surveys on all medical faculties in Germany to examine for potential discrepancies between the implementation process and their intended consequences on teaching time and content. METHODS Four consecutive bi-annual surveys (2006, 2008, 2010, 2012) of all 36 medical faculties in Germany were performed, using purposively for this study developed questionnaires. Likert scales and closed questions were analyzed descriptively. RESULTS Medical Faculty response rate increased from 50 % in 2006 to 88.9 % in 2012. Teaching coordinators in palliative medicine primarily had an anesthesiology or internal medicine background. There was a noted increase over time of the involvement of specialized palliative care units (PCUs) as providing the setting for education. The number of faculties that were able to offer a complete 16 weeks of training in palliative medicine during the "final year" rose steadily. In addition, increased patient-centered teaching formats have been implemented over time. The faculties which offered innovative teaching formats with actors as patients (standardized patient interaction) increased, as did the total number of mandatory examinations. The number of faculties that provided compulsory teaching in a condensed manner within a single academic year increased sharply from 3 of 31 responding faculties in 2010 to 19 of 32 responding faculties in 2012. CONCLUSIONS Until now, teaching conditions and structures in palliative medicine in Germany have proven to be extraordinarily heterogeneous. Although professorships ("Chairs") in palliative medicine proved to be particularly beneficial and supportive in curricular and structural development, only a minority of faculties provide leading academic positions in palliative medicine.
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Affiliation(s)
- Benjamin Ilse
- Department of Neurology, University Medical Center, Göttingen, Germany.
| | - Bernd Alt-Epping
- Department of Palliative Medicine, University Medical Center, Göttingen, Germany.
| | - Isabel Kiesewetter
- Department of Palliative Medicine, Munich University Hospital, Munich, Germany.
- Department of Anesthesiology, Munich University Hospital, Munich, Germany.
| | - Frank Elsner
- Department of Palliative Medicine, Uniklinik RWTH Aachen University, Aachen, Germany.
| | - Johanna Hildebrandt
- Vestische Children's Hospital, University of Witten/ Herdecke, Datteln, Germany.
| | - Alexander Laske
- Department of Anaesthesiology, University Medicine Greifswald, Greifswald, Germany.
- Sana Arztpraxen Rügen, Bergen, Germany.
| | - Alexandra Scherg
- Interdisciplinary Centre for Palliative Medicine, University Hospital Dusseldorf, Dusseldorf, Germany.
| | - Christine Schiessl
- Department of Anesthesiology, University of Erlangen-Nuremberg, Erlangen, Germany.
- Algesiologikum - Pain Center, Munich, Germany.
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[Knowledge and attitude of medical students in Germany towards palliative care : Does the final year of medical school make a difference?]. Schmerz 2015; 30:279-85. [PMID: 26351127 DOI: 10.1007/s00482-015-0055-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The practical year (PY) during the final year of medical education is intended to deepen and broaden knowledge, skills, and abilities that were acquired during previous years of their studies. Against this background, this study pursues the question of how the knowledge of future physicians and their confidence in terms of cancer pain therapy and other palliative care issues develops during the PY. MATERIALS AND METHODS At the end of the PY, students from two university hospitals completed a 3-part online questionnaire (self-assessment of the confidence, questions about palliative care knowledge, and assessment of palliative care training during the PY). These results are compared with previously published data from the same collective that had been collected at the beginning of the PY. RESULTS Overall, 92 of 318 students participated (28.9 %). Less than 10 % of students said that they were more confident regarding palliative care topics at the end of their medical studies. Improvements in the self-assessment could only be observed in the recognition of and screening for cancer pain (increase from 36 % to 65%). With regard to the palliative care knowledge, only the knowledge of how to treat symptoms other than pain improved significantly; however, knowledge in this regard prior to the PY was particularly low (an increase from 25 % to 35 %, p < 0.05). In the only multiple-choice question about ethics, the correct answer rose slightly from 51 % (before) to 55 % (after the PY). Of participating students, 21% (prior to the PY 27 %) stated that not providing fluids to dying patients is a form of euthanasia. In terms of palliative care training, between 36 and 83 % of participants stated having insufficient opportunities to gain knowledge and experience on various topics in the treatment of patients with advanced and incurable diseases during their PY. CONCLUSION In the present study, considerable deficits in confidence and knowledge regarding palliative care issues were also observed at the end of PY. Integration of palliative care into the medical school curriculums should be given special attention in terms of a longitudinal training of the PY.
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Gerlach C, Mai S, Schmidtmann I, Massen C, Reinholz U, Laufenberg-Feldmann R, Weber M. Does Interdisciplinary and Multiprofessional Undergraduate Education Increase Students' Self-Confidence and Knowledge Toward Palliative Care? Evaluation of an Undergraduate Curriculum Design for Palliative Care at a German Academic Hospital. J Palliat Med 2015; 18:513-9. [DOI: 10.1089/jpm.2014.0337] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Christina Gerlach
- Interdisciplinary Palliative Care Unit, Department of Medicine, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- Community Service for Specialized Palliative Care, Hospice of Mainz, Mainz, Germany
| | - Sandra Mai
- Interdisciplinary Palliative Care Unit, Department of Medicine, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Irene Schmidtmann
- Institute for Medical Biometry, Epidemiology and Computer Science, Johannes Gutenberg University, Mainz, Germany
| | - Clara Massen
- Interdisciplinary Palliative Care Unit, Department of Medicine, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Ulrike Reinholz
- Interdisciplinary Palliative Care Unit, Department of Medicine, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Rita Laufenberg-Feldmann
- Department of Anesthesiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Martin Weber
- Interdisciplinary Palliative Care Unit, Department of Medicine, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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Tai V, Cameron-Taylor E, Clark K. A mixed methodology retrospective analysis of the learning experience of final year medical students attached to a 1-week intensive palliative care course based at an Australian university. Am J Hosp Palliat Care 2013; 31:636-40. [PMID: 23884901 DOI: 10.1177/1049909113496451] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIMS To assess the experiences in an established 1-week palliative care placement for final year medical students attending the University of Newcastle, New South Wales, Australia. DESIGN A retrospective, mixed methodology, consecutive cohort. Student data collected included satisfaction feedback scores, open-ended questions and palliative medicine multiple-choice results before and after their 1-week placement. RESULTS Although there were high satisfaction ratings and objective improvements (P < .001) seen in multiple-choice quiz scores, a subset did not improve. Practical issues such as prescribing, opioid use, and conversions were particularly valued by students. More teaching time and practical experience were requested. DISCUSSION Given the importance of palliative care teaching within a medical degree, the results suggest continued development and review of palliative medical education are essential.
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Affiliation(s)
- Vicki Tai
- Department of Palliative Care, Calvary Mater Newcastle, Warabrook, New South Wales , Australia The University of Newcastle, New South Wales , Australia Central Coast Palliative Care Services, New South Wales , Australia
| | - Erica Cameron-Taylor
- Department of Palliative Care, Calvary Mater Newcastle, Warabrook, New South Wales , Australia The University of Newcastle, New South Wales , Australia
| | - Katherine Clark
- Department of Palliative Care, Calvary Mater Newcastle, Warabrook, New South Wales , Australia The University of Newcastle, New South Wales , Australia
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