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Fortin Magaña M, Diaz S, Salazar-Colocho P, Feng A, López-Saca M. Long-term effects of an undergraduate palliative care course: a prospective cohort study in El Salvador. BMJ Support Palliat Care 2024; 14:200-207. [PMID: 33219104 DOI: 10.1136/bmjspcare-2020-002311] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 09/14/2020] [Accepted: 10/07/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND International organisations recommend the inclusion of palliative care undergraduate education as a way to meet increasing demand; the long-term effects, however, are unknown. Since 2013 the Dr José Matías Delgado University has offered an undergraduate course for palliative care. AIMS To assess whether a palliative care course results in improvement in self-perceived comfort among students and if it lasts up to 4 years later; and to examine students' knowledge of palliative care and assess the relationship between comfort and knowledge. DESIGN This is a prospective cohort study where students attending the course were requested to complete the Scale of Self-Perceived Comfort in palliative care pre and post course. Participants were contacted in 2018 and a group without palliative care education was established as a control group, matched one-to-one according to current academic level. They were asked to complete the Scale of Self-Perceived Comfort questionnaire together with the Palliative Care Knowledge Test. SETTINGS/PARTICIPANTS 83 students who attended the course between the years 2014 and 2017 and 101 controls. RESULTS In the postcourse test, participants had a 1.13-point increase (p≤0.001) in comfort, which persisted 4 years later and was superior to the control group by 0.6 points (p≤0.001). The control group showed no difference in the precourse test despite having more clinical experience (p=0.68). The students outscored the control group in the knowledge test by 4.2 points (p≤0.001). There appears to be no correlation between comfort and knowledge. CONCLUSION A palliative care undergraduate course results in improvement in student comfort and knowledge which persists up to 4 years later.
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Affiliation(s)
- Miguel Fortin Magaña
- Palliative Medicine, Dr Jose Matias Delgado University, San Salvador, El Salvador
| | - Susana Diaz
- Palliative Medicine, Dr Jose Matias Delgado University, San Salvador, El Salvador
| | | | - Ancu Feng
- Palliative Medicine, Dr Jose Matias Delgado University, San Salvador, El Salvador
| | - Mario López-Saca
- Palliative Medicine, Dr Jose Matias Delgado University, San Salvador, El Salvador
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Gagnon B, Boyle A, Jolicoeur F, Labonté M, Taylor K, Downar J. Palliative care clinical rotations among undergraduate and postgraduate medical trainees in Canada: a descriptive study. CMAJ Open 2020; 8:E257-E263. [PMID: 32291264 PMCID: PMC7162608 DOI: 10.9778/cmajo.20190138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The number of medical undergraduate and postgraduate students completing palliative care clinical rotations in Canadian medical schools is currently unknown. The aim of this study was to assess the proportion of Canadian medical trainees completing clinical rotations in palliative care and to determine whether changes took place between 2008 and 2018. METHODS In this descriptive study, all Canadian medical schools (n = 17) were invited to provide data at the undergraduate and postgraduate levels (2007/08-2015/16 and 2007/08-2017/18, respectively). Information collected included the number, type and length of palliative care clinical rotations offered and the total number of medical trainees or residents enrolled at each school. RESULTS All 17 Canadian medical schools responded to the request for information. At the undergraduate level, palliative care clinical rotations were not offered in 2 schools, mandatory in 2 and optional in 13. Three schools that offered optional rotations were unable to provide complete data and were therefore excluded from further analyses. In 2015/16, only 29.7% of undergraduate medical students completed palliative care clinical rotations, yet this was a significant improvement compared to 2011/12 (13.6%, p = 0.02). At the postgraduate level, on average, 57.9% of family medicine trainees completed such rotations between 2007/08 and 2016/17. During the same period, palliative care clinical rotations were completed by trainees in specialty or subspecialty programs in anesthesiology (34.2%), geriatric medicine (64.4%), internal medicine (30.9%), neurology (28.2%) and psychiatry (64.5%). INTERPRETATION Between 2008 and 2018, a large proportion of Canadian medical trainees graduated without the benefit of a clinical rotation in palliative care. Without dedicated clinical exposure to palliative care, many physicians will enter practice without vital palliative care competencies.
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Affiliation(s)
- Bruno Gagnon
- Faculty of Medicine (Gagnon), Laval University; Research Centre of the Centre hospitalier universitaire de Québec-Université Laval (Gagnon, Jolicoeur, Labonté), Québec, Que.; Canadian Society of Palliative Care Physicians (Boyle, Taylor, Downar), Surrey, BC; Department of Family Medicine (Boyle), McMaster University, Hamilton, Ont.; Department of Medicine (Downar), University of Ottawa, Ottawa, Ont.
| | - Anne Boyle
- Faculty of Medicine (Gagnon), Laval University; Research Centre of the Centre hospitalier universitaire de Québec-Université Laval (Gagnon, Jolicoeur, Labonté), Québec, Que.; Canadian Society of Palliative Care Physicians (Boyle, Taylor, Downar), Surrey, BC; Department of Family Medicine (Boyle), McMaster University, Hamilton, Ont.; Department of Medicine (Downar), University of Ottawa, Ottawa, Ont
| | - Fabienne Jolicoeur
- Faculty of Medicine (Gagnon), Laval University; Research Centre of the Centre hospitalier universitaire de Québec-Université Laval (Gagnon, Jolicoeur, Labonté), Québec, Que.; Canadian Society of Palliative Care Physicians (Boyle, Taylor, Downar), Surrey, BC; Department of Family Medicine (Boyle), McMaster University, Hamilton, Ont.; Department of Medicine (Downar), University of Ottawa, Ottawa, Ont
| | - Mauranne Labonté
- Faculty of Medicine (Gagnon), Laval University; Research Centre of the Centre hospitalier universitaire de Québec-Université Laval (Gagnon, Jolicoeur, Labonté), Québec, Que.; Canadian Society of Palliative Care Physicians (Boyle, Taylor, Downar), Surrey, BC; Department of Family Medicine (Boyle), McMaster University, Hamilton, Ont.; Department of Medicine (Downar), University of Ottawa, Ottawa, Ont
| | - Kim Taylor
- Faculty of Medicine (Gagnon), Laval University; Research Centre of the Centre hospitalier universitaire de Québec-Université Laval (Gagnon, Jolicoeur, Labonté), Québec, Que.; Canadian Society of Palliative Care Physicians (Boyle, Taylor, Downar), Surrey, BC; Department of Family Medicine (Boyle), McMaster University, Hamilton, Ont.; Department of Medicine (Downar), University of Ottawa, Ottawa, Ont
| | - James Downar
- Faculty of Medicine (Gagnon), Laval University; Research Centre of the Centre hospitalier universitaire de Québec-Université Laval (Gagnon, Jolicoeur, Labonté), Québec, Que.; Canadian Society of Palliative Care Physicians (Boyle, Taylor, Downar), Surrey, BC; Department of Family Medicine (Boyle), McMaster University, Hamilton, Ont.; Department of Medicine (Downar), University of Ottawa, Ottawa, Ont
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Boland JW, Barclay S, Gibbins J. Twelve tips for developing palliative care teaching in an undergraduate curriculum for medical students. MEDICAL TEACHER 2019; 41:1359-1365. [PMID: 30689479 DOI: 10.1080/0142159x.2018.1533243] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Palliative care is the holistic care of patients with advanced, progressive incurable illness. Palliative care is well recognized as an essential component of medical student curricula. However, teaching is variable within medical schools. Using current literature, these tips aim to highlight key points necessary to facilitate the development and delivery of palliative care teaching to medical students. The key practice points include: clinical exposure to patients with palliative care needs and those that are dying, being compulsory (and integrated) across the course, summative and formative assessments to encourage learning, support from within the university for curricular time and development, visits to a hospice/inpatient palliative care facility, emphasis on clinically based learning later in the course, teaching by specialists in palliative care as well as specialists in other areas including Family Doctors/General Practitioners, innovative teaching methods and inter-professional learning to develop teaching.
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Affiliation(s)
- Jason W Boland
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Stephen Barclay
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jane Gibbins
- St Julia's Hospice, Cornwall Hospice Care, Hayle, UK
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Palliative care education in Latin America: A systematic review of training programs for healthcare professionals. Palliat Support Care 2017; 16:107-117. [DOI: 10.1017/s147895151700061x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTObjective:The integration of palliative care (PC) education into medical and nursing curricula has been identified as an international priority. PC education has undergone significant development in Latin America, but gaps in the integration of PC courses into undergraduate and postgraduate curricula remain. The aim of our review was to systematically examine the delivery of PC education in Latin America in order to explore the content and method of delivery of current PC programs, identify gaps in the availability of education opportunities, and document common barriers encountered in the course of their implementation.Method:We carried out a systematic review of peer-reviewed academic articles and grey literature. Peer-reviewed articles were obtained from the following databases: CINAHL Plus, Embase, the Web of Science, and Medline. Grey literature was obtained from the following directories: the International Association for Hospice and Palliative Care's Global Directory of Education in Palliative Care, the Worldwide Hospice Palliative Care Alliance's lists of palliative care resources, the Latin American Association for Palliative Care's training resources, and the Latin American Atlas of Palliative Care. The inclusion criteria were that the work: (1) focused on describing PC courses; (2) was aimed at healthcare professionals; and (3) was implemented in Latin America. The PRISMA checklist was employed to guide the reporting of methods and findings.Results:We found 36 programs that were delivered in 8 countries. Most of the programs were composed of interdisciplinary teams, taught at a postgraduate level, focused on pain and symptom management, and utilized classroom-based methods. The tools for evaluating the courses were rarely reported. The main barriers during implementation included: a lack of recognition of the importance of PC education, a lack of funding, and the unavailability of trained teaching staff.Significance of results:Considerable work needs to be done to improve the delivery of PC education programs in Latin American countries. Practice-based methods and exposure to clinical settings should be integrated into ongoing courses to facilitate learning. A regional platform needs to be created to share experiences of successful training programs and foster the development of PC education throughout Latin America.
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The contribution of undergraduate palliative care education: does it influence the clinical patient's care? Curr Opin Support Palliat Care 2016; 9:375-91. [PMID: 26418527 DOI: 10.1097/spc.0000000000000169] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The aim of this 2-year systematic review is to understand how learner assessment and curriculum evaluation of education in palliative care is being undertaken and to examine whether current undergraduate education influences the clinical patient's care. RECENT FINDINGS Almost half of the 30 studies reviewed used a qualitative approach to evaluate learning experiences. Only three of them were controlled studies and a further one was a cohort study.When students openly express themselves, they agree that there is 'something' deep as regards the core or the essence of medical practice or nursing. They feel that they become better professionals and better prepared for the patients, not only in terms of end of life care, but also as regards care, irrespective of the phase of the disease.The inclusion of palliative care in undergraduate education is a way of providing knowledge, skill, and competences about palliative care (especially communication) and also improving attitudes toward caring in advanced disease and at the end of life. Different methods of experiential learning, even brief experiences, which bring students into close contact with palliative care clinical cases or patients, are providing better results. SUMMARY From research studies, there is only indirect evidence that palliative care training at university leads to better clinical care of patients. In the future, long-term cohort or controlled studies might answer that question.
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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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Strasser-Weippl K, Chavarri-Guerra Y, Villarreal-Garza C, Bychkovsky BL, Debiasi M, Liedke PER, Soto-Perez-de-Celis E, Dizon D, Cazap E, de Lima Lopes G, Touya D, Nunes JS, St Louis J, Vail C, Bukowski A, Ramos-Elias P, Unger-Saldaña K, Brandao DF, Ferreyra ME, Luciani S, Nogueira-Rodrigues A, de Carvalho Calabrich AF, Del Carmen MG, Rauh-Hain JA, Schmeler K, Sala R, Goss PE. Progress and remaining challenges for cancer control in Latin America and the Caribbean. Lancet Oncol 2016; 16:1405-38. [PMID: 26522157 DOI: 10.1016/s1470-2045(15)00218-1] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 08/03/2015] [Accepted: 08/04/2015] [Indexed: 12/22/2022]
Abstract
Cancer is one of the leading causes of mortality worldwide, and an increasing threat in low-income and middle-income countries. Our findings in the 2013 Commission in The Lancet Oncology showed several discrepancies between the cancer landscape in Latin America and more developed countries. We reported that funding for health care was a small percentage of national gross domestic product and the percentage of health-care funds diverted to cancer care was even lower. Funds, insurance coverage, doctors, health-care workers, resources, and equipment were also very inequitably distributed between and within countries. We reported that a scarcity of cancer registries hampered the design of credible cancer plans, including initiatives for primary prevention. When we were commissioned by The Lancet Oncology to write an update to our report, we were sceptical that we would uncover much change. To our surprise and gratification much progress has been made in this short time. We are pleased to highlight structural reforms in health-care systems, new programmes for disenfranchised populations, expansion of cancer registries and cancer plans, and implementation of policies to improve primary cancer prevention.
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Affiliation(s)
- Kathrin Strasser-Weippl
- Centre for Oncology and Hematology, Wilhelminen Hospital, Vienna, Austria; The Global Cancer Institute, Boston, MA, USA
| | - Yanin Chavarri-Guerra
- The Global Cancer Institute, Boston, MA, USA; Hemato-Oncology Department, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico; Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Cynthia Villarreal-Garza
- Instituto de Cancerología, Centro de Cáncer de Mama, Tecnologico de Monterrey, Monterrey, Nuevo León, Mexico; Departmento de Investigación y de Tumores Mamarios, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - Brittany L Bychkovsky
- Dana Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Marcio Debiasi
- Hospital Mae de Deus, Porto Alegre, Rio Grande do Sul, Brazil; Hospital Sao Lucas da PUCRS, Porto Alegre, Rio Grande do Sul, Brazil
| | - Pedro E R Liedke
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Instituto do Câncer Mãe de Deus, Porto Alegre, Rio Grande do Sul, Brazil
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Cancer Care in the Elderly Clinic, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico
| | - Don Dizon
- Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Eduardo Cazap
- Sociedad Latinoamericana y del Caribe de Oncología Médica, Buenos Aires, Argentina
| | - Gilberto de Lima Lopes
- Medical Oncology, Centro Paulista de Oncologia and Oncoclinicas do Brasil Group, São Paulo, Brazil; Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Diego Touya
- Department of Oncology, University of the Republic, Montevideo, Uruguay
| | | | - Jessica St Louis
- The Global Cancer Institute, Boston, MA, USA; Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Caroline Vail
- The Global Cancer Institute, Boston, MA, USA; Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Alexandra Bukowski
- The Global Cancer Institute, Boston, MA, USA; Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Pier Ramos-Elias
- Instituto de Cancerología, Centro de Cáncer de Mama, Tecnologico de Monterrey, Monterrey, Nuevo León, Mexico
| | - Karla Unger-Saldaña
- Cátedra CONACYT, Unidad de Epidemiología, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | | | - Mayra E Ferreyra
- Oncology Department, Maria Curie Hospital, Buenos Aires, Argentina
| | - Silvana Luciani
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Angelica Nogueira-Rodrigues
- Federal University, Minas Gerais, Brazil; EVA-Group Brasileiro de Tumores Ginecológicos, Brazilian Gynecologic Oncology Group, Bahia, Brazil
| | | | - Marcela G Del Carmen
- Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Jose Alejandro Rauh-Hain
- Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Raúl Sala
- Grupo Argentino de Investigación Clínica en Oncología-GAICO, Rosario, Santa Fe, Argentina
| | - Paul E Goss
- The Global Cancer Institute, Boston, MA, USA; Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, 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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