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Fiuza M, Silva Junior G. Listening to the Residents: The Perception of Pediatric Palliative Care Education in a Residency Program in Brazil. Am J Hosp Palliat Care 2023; 40:1067-1073. [PMID: 36592475 DOI: 10.1177/10499091221149153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background: In Brazil, a relevant portion and children suffer without receiving adequate control of their symptoms. Failures in pediatrician training may contribute to this problem. Objective: The goal was to characterize the educational failures perceived by pediatric residents for pediatric palliative care throughout their training. Methods: A cross-sectional study was carried out, with the application of the Pediatric Palliative Care Questionnaire (QCPP) to residents of three pediatrics and specialties of public limits at the Escola de Saúde Pública do Estado do Ceará (ESP-CE), Brazil. Results: The response rate was 68 out of 123 residents (55%). It was reported that they did not consider the specialty as patient care or death. He also feels comfortable explaining the physiological process of dying to his family. The time devoted to CPP teaching, as well as medical residency, was considered reduced. For those who attended a subspecialty, the number they signaled was "0 hours" at 82.40%. Conclusion: It can be said that the main flaws in the teaching-learning process of pediatric residents were the number of hours of training in teaching, communication skills training (through participation in conferences) and guidance on the practice of teaching suspension of invasive measures. It was observed that less time reserved for this learning is related to lesser knowledge and greater barriers to the use of palliative care. Those who declared themselves able to take care of children with life-organizing conditions received some teaching in CPP.
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Affiliation(s)
- Marcia Fiuza
- UNIFOR-Universidade de Fortaleza, Fortaleza, Brazil
| | - Geraldo Silva Junior
- UNIFOR-Universidade de Fortaleza, Fortaleza, Brazil
- UFC-Universidade Federal do Ceará, Fortaleza, Brazil
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2
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Zanello E, Vecchi R, Zamagni G, Biagi MC, Bruno I, Cragnolin E, Danielli E, Paoletti S, Rabusin M, Ronfani L, Pessa Valente E. Measuring Knowledge of Healthcare Providers on Pediatric Palliative Care with an Online Questionnaire Based on the National Core Curriculum in Italy. Healthcare (Basel) 2023; 11:1971. [PMID: 37444805 DOI: 10.3390/healthcare11131971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/03/2023] [Accepted: 07/06/2023] [Indexed: 07/15/2023] Open
Abstract
There is a lack of highly reliable tools evaluating healthcare professionals' competences on Pediatric Palliative Care (PPC) and Pain Therapy (PT). The aim of this study is to document the development of an online questionnaire to assess Perceived, Wished and Actual Knowledge of healthcare workers on PPC/PT. The tool was built on the basis of the Italian Society for Palliative Care PPC Core Curriculum (CC) for physicians, nurses and psychologists. Face validity, internal consistency and the underlying structure were evaluated after a field testing in a referral hospital, Friuli-Venezia Giulia, Italy. One hundred five respondents completed the questionnaire. High internal consistency for both scales of Perceived and Wished Knowledge was found (α = 0.95 and α = 0.94, respectively). Psychologists reported higher levels of self-Perceived skills on the psychosocial needs of the child and family at the end of life (p = 0.006), mourning (p = 0.003) and ethics and deontology in PT/PC (p = 0.049). Moreover, when Actual Knowledge was tested, they also provided the highest number of correct answers (p = 0.022). No differences were found by profession for Wished Knowledge. The questionnaire showed promising psychometric properties. Our findings suggest the need of continuous training in this field and identify contents to be addressed in future training programs.
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Affiliation(s)
- Elisa Zanello
- Institute for Maternal and Child Health IRCSS "Burlo Garofolo", 34137 Trieste, Italy
| | | | - Giulia Zamagni
- Institute for Maternal and Child Health IRCSS "Burlo Garofolo", 34137 Trieste, Italy
| | - Maria Celeste Biagi
- Institute for Maternal and Child Health IRCSS "Burlo Garofolo", 34137 Trieste, Italy
| | - Irene Bruno
- Institute for Maternal and Child Health IRCSS "Burlo Garofolo", 34137 Trieste, Italy
| | - Elisa Cragnolin
- Institute for Maternal and Child Health IRCSS "Burlo Garofolo", 34137 Trieste, Italy
| | - Elisabetta Danielli
- Institute for Maternal and Child Health IRCSS "Burlo Garofolo", 34137 Trieste, Italy
| | - Silvia Paoletti
- ANVOLT Trieste-Associazione Nazionale Volontari Lotta Contro i Tumori, 34135 Trieste, Italy
| | - Marco Rabusin
- Institute for Maternal and Child Health IRCSS "Burlo Garofolo", 34137 Trieste, Italy
| | - Luca Ronfani
- Institute for Maternal and Child Health IRCSS "Burlo Garofolo", 34137 Trieste, Italy
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3
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López-García M, Rubio L, Martin-de-Las-Heras S, Suárez J, Pérez-Cárceles MD, Martin-Martin J. Instruments to measure skills and knowledge of physicians and medical students in palliative care: A systematic review of psychometric properties. MEDICAL TEACHER 2022; 44:1133-1145. [PMID: 35486883 DOI: 10.1080/0142159x.2022.2067033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Palliative care is constantly increasing around the world. The knowledge and skills of future physicians in this area are crucial. This study evaluates the psychometric properties of knowledge and skills questionnaires used in palliative care, validated by physicians or medical students based on the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. METHODS A systematic review was carried out in Cosmin Databases, Cochrane Library, PsycINFO, SciELO, Cinahl, and Medline up to September 2020 (updated June 2021), based on the COSMIN methodology and PRISMA recommendations. The psychometric properties of each included questionnaire were identified. Methodological quality, quality of results, and quality of evidence were evaluated. RESULTS The search strategy yielded 12 questionnaires assessing the knowledge and skills of physicians or medical students. The Palliative Care Knowledge Questionnaire for PEACE (PEACE-Q) and Palliative Care Knowledge Test (PCKT) were the instruments with the highest scores for methodological quality, quality of results, and quality of evidence-based on the COSMIN methodology. CONCLUSIONS PEACE-Q and PCKT should be the preferred choice to assess palliative care knowledge and skills in physicians. In-depth studies following COSMIN validation criteria are recommended to improve the psychometric properties and cross-cultural validation of the questionnaires.
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Affiliation(s)
- Mónica López-García
- Cudeca Hospice (Palliative Care Foundation), Málaga, Spain
- Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
| | - Leticia Rubio
- Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
- Department of Legal Medicine, Facultad de Medicina, Universidad de Málaga, Málaga, Spain
| | - Stella Martin-de-Las-Heras
- Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
- Department of Legal Medicine, Facultad de Medicina, Universidad de Málaga, Málaga, Spain
| | - Juan Suárez
- Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
- Department of Legal Medicine, Facultad de Medicina, Universidad de Málaga, Málaga, Spain
| | - María D Pérez-Cárceles
- Department of Legal and Forensic Medicine, Faculty of Medicine, Biomedical Research Institute (IMIB-Arrixaca), University of Murcia, Murcia, Spain
| | - Jaime Martin-Martin
- Cudeca Hospice (Palliative Care Foundation), Málaga, Spain
- Department of Legal Medicine, Facultad de Medicina, Universidad de Málaga, Málaga, Spain
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4
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Hamre TJ, O'Shea ER, Hinderer KA, Mosha MH, Wentland BA. Impact of an Evidence-Based Pediatric Palliative Care Program on Nurses' Self-Efficacy. J Contin Educ Nurs 2022; 53:264-272. [PMID: 35647631 DOI: 10.3928/00220124-20220505-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background The purpose of this study was to determine the effect of a 1-day evidence-based pediatric palliative care continuing professional development program on nurses' and advanced practice registered nurses' perceived self-efficacy regarding palliative care. Method The revised Pediatric Palliative Care Questionnaire was administered to participants before and after a 7½-hour program. A multimodal approach was used to teach topics specific to pediatric palliative care. Results Thirty-one participants completed questionnaires. Notably, most of the participants had provided palliative or end-of-life care, but few had previous education specific to pediatrics. The self-efficacy scores of the participants significantly increased after program attendance (Z = 3.53, p < .001). Conclusion Continuing professional development in pediatric palliative care improves nurses' and advanced practice registered nurses' confidence in their skills to provide this care. Findings of this study support the need for pediatric-specific education in nursing training programs and continuing professional development offerings. Continuing education may be the key to improving access to high-quality care for children living with serious illness and their families. [J Contin Educ Nurs. 2022;53(6):264-272.].
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Falk EE, Allen KE, DeGroote NP, Wasilewski-Masker K, Brock KE. Feasibility, Acceptability, and Education of Pediatric Oncology Providers Before and After an Embedded Pediatric Palliative Oncology Clinic. JCO Oncol Pract 2021; 17:e714-e729. [PMID: 33606559 DOI: 10.1200/op.20.00881] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Most pediatric palliative care (PPC) education is trainee-directed, didactic, or simulation-based and therefore limited in scope, realism, and audience. We explored whether an embedded pediatric palliative oncology (PPO) clinic is associated with improved pediatric oncology provider palliative care comfort, knowledge, and attitudes toward PPC and if the model is feasible for both clinical care and education of providers of all levels. METHODS Oncology providers (oncologists, advanced practice providers, and fellows) were enrolled in this study. Based on interaction with the PPO clinic, two cohorts were defined: PPO providers (n = 11, 37.9%) and non-PPO providers (n = 18, 62.1%). Providers in both groups responded to qualitative and quantitative questionnaires about the feasibility and acceptability of PPO clinic, their attitudes toward PPC, and knowledge and comfort in PPC concepts at baseline and 1 year. Descriptive statistics were performed; demographic and outcome variables across cohorts by PPO grouping and experience were compared. RESULTS All 29 pediatric oncology providers reported acceptability of a PPO clinic and favorable attitudes about PPC. The most feasible clinic model was oncology followed by PPO visits. Non-PPO group and less experienced (≤ 10 years) providers had greater improvement in knowledge and comfort with PPC skills than PPO group or more experienced providers. Providers lacked comfort in non-pain symptom management skills. CONCLUSION This embedded PPO clinic model was feasible, acceptable, and highly rated by responding oncology clinicians, but was insufficient as a sole method of educating multidisciplinary oncology providers. Methods of combining clinical and formal education are needed to impart sustained educational change.
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Affiliation(s)
- Erin E Falk
- Emory University School of Medicine, Atlanta, GA
| | - Kristen E Allen
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA
| | - Nicholas P DeGroote
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA
| | - Karen Wasilewski-Masker
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA.,Department of Pediatrics, Division of Pediatric Hematology/Oncology, Emory University, Atlanta, GA
| | - Katharine E Brock
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA.,Department of Pediatrics, Division of Pediatric Hematology/Oncology, Emory University, Atlanta, GA.,Department of Pediatrics, Division of Palliative Care, Emory University, Atlanta, GA
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6
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Topperzer MK, Thellesen L, Hoffmann M, Larsen HB, Weibel M, Lausen B, Schmiegelow K, Sørensen JL. Establishment of consensus on content and learning objectives for an interprofessional education in childhood cancer: a Delphi survey. BMJ Paediatr Open 2020; 4:e000634. [PMID: 32342017 PMCID: PMC7173955 DOI: 10.1136/bmjpo-2019-000634] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 03/06/2020] [Accepted: 03/10/2020] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Complex treatment, care and rehabilitation require continuous healthcare professional development and maintenance of competencies in collaboration with other professionals. Interprofessional education in childhood cancer involves several groups of healthcare professionals with both general and specific knowledge and skills. OBJECTIVE To establish consensus on content and interprofessional learning objectives for an interprofessional education in childhood cancer. DESIGN A three-round Delphi survey in Scandinavian childhood cancer departments. PARTICIPANTS Healthcare professionals appointed by their head of departments and head nurses based on their profession and their involvement in continuing professional development. MAIN OUTCOME MEASURES A prioritised list of interprofessional learning objectives with a mean score of ≥3 on a five-point scale (1=not relevant, 5=extremely relevant). RESULTS 12 childhood cancer departments participated with 30 healthcare professionals: 11 nurses, 10 medical doctors, 5 social workers, 2 physiotherapists and 2 pedagogues. In total, 28 (93%), 25 (83%) and 22 (73%) completed the first, second and third round, respectively. In the first round, we asked open-ended questions and used directed content analysis to analyse 386 statements. We formulated 170 interprofessional learning objectives in six categories: (1) acute life-threatening situations, (2) gastrointestinal toxicities and side effects, (3) pain, (4) palliation, (5) play and activity, and (6) prescription and administration of medicine. The second round resulted in 168 interprofessional learning objectives receiving a mean score of ≥3 on a five-point scale. Final agreement in the third round resulted in a prioritised list of 168 learning objectives. CONCLUSIONS Consensus on content and interprofessional learning objectives for an interprofessional education in childhood cancer was established across five groups of healthcare professionals in three countries. Some learning objectives are generic and can be applied in settings other than childhood cancer, where healthcare professionals collaborate to provide patients and families optimal treatment and care.
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Affiliation(s)
- Martha Krogh Topperzer
- Paediatric Oncology Research Laboratory, Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Kobenhavn, Denmark
| | - Line Thellesen
- Department of Obstetrics, Herlev Hospital, Herlev, Denmark
| | - Marianne Hoffmann
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Kobenhavn, Denmark
| | - Hanne Baekgaard Larsen
- Paediatric Oncology Research Laboratory, Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Kobenhavn, Denmark
- Department of Clinical Medicine, University of Copenhagen, Kobenhavn, Denmark
| | - Mette Weibel
- Paediatric Oncology Research Laboratory, Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Kobenhavn, Denmark
| | - Birgitte Lausen
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Kobenhavn, Denmark
| | - Kjeld Schmiegelow
- Paediatric Oncology Research Laboratory, Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Kobenhavn, Denmark
- Department of Clinical Medicine, University of Copenhagen, Kobenhavn, Denmark
| | - Jette Led Sørensen
- Department of Clinical Medicine, University of Copenhagen, Kobenhavn, Denmark
- Juliane Marie Centre, Rigshospitalet, Kobenhavn, Denmark
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Niehaus JZ, Palmer M, LaPradd M, Haskamp A, Hatton A, Scanlon C, Hill AB. Pediatric Resident Perception and Participation in End-of-Life Care. Am J Hosp Palliat Care 2020; 37:936-942. [PMID: 32193956 DOI: 10.1177/1049909120913041] [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: 11/16/2022] Open
Abstract
BACKGROUND Despite advances in medical care, pediatric deaths are still an unfortunate reality. Most of these deaths occur within a hospital setting. End-of-life care is an important part of medical care for children with serious illnesses. Despite the importance, pediatric providers report a lack of comfort surrounding end-of-life care. OBJECTIVE To assess categorical pediatric residents' perceptions and participation in providing end-of-life care to dying children and their families. STUDY DESIGN This is a survey-based, descriptive, mixed-methods study. Survey was sent to categorical pediatric residents at Indiana University School of Medicine in June 2018 to obtain both quantitative and qualitative information on resident perception and participation in end-of-life care. Surveys were sent to 100 residents with a response rate of 68%. SETTING/PARTICIPANTS Pediatric residents at Indiana University School of Medicine. RESULTS The comfort and participation in end-of-life care are limited in all levels of pediatric training. Residents do not feel comfortable with 19 of 22 questions related to end-of-life care. Only 32% of residents felt their education prepared them to participate in end-of-life care. Almost one-fifth (19.5%) of residents report participating in zero aspect of end-of-life care. Themes discussed by residents include education, experience, communication, social norms, emotions, self-care, comfort, and family. CONCLUSION More formalized education and training is needed to increase resident comfort with and participation in end-of-life care. Such future interventions should focus on communication surrounding difficult conversations and providing guidance for families.
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Affiliation(s)
- Jason Z Niehaus
- Division of Neonatal-Perinatal Medicine, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Megan Palmer
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michelle LaPradd
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis IN, USA
| | - Amy Haskamp
- Division Palliative Care, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Amy Hatton
- Division Palliative Care, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Caitlin Scanlon
- Division Palliative Care, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Adam B Hill
- Division Palliative Care, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
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8
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Wong KY, Li WTV, Yiu PY, Tong TK, Ching OH, Leung LY, Cheung TY, Chan SC, Law HY, Cheng CH. New Directions in Pediatric Palliative Care Education for Preclinical Medical and Nursing Students. MEDICAL SCIENCE EDUCATOR 2020; 30:445-455. [PMID: 34457688 PMCID: PMC8368940 DOI: 10.1007/s40670-020-00928-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Since insufficient education has partially contributed to challenges in providing pediatric palliative care (PPC), a cross-sectional questionnaire study was conducted to explore the knowledge, attitudes, and educational needs of preclinical medical and nursing students in Hong Kong. METHODS Pretested self-administered 44-item questionnaires with written informed consent were distributed to 241 medical and nursing students at Li Ka Shing Faculty of Medicine, the University of Hong Kong, between February and March 2019. This questionnaire covered eleven categories related to participants' knowledge of and attitudes towards PPC. A convenience sampling method was used. Data analysis was performed with descriptive statistics, chi-squared, and Fisher's exact test. RESULTS Only 38.3% of participants had heard of PPC before, but 73.5% advocated for its local commencement. A large number, with more in nursing, misunderstood fundamental palliative concepts and pain assessment methods. Many reported that undergraduate curricula should include PPC since they were not prepared to deal and cope with dying children. More medical students identified multidisciplinary approaches in PPC while less believed that they were mentally prepared to discuss death and dying. The majority indicated family as the final decision maker, even for teenage patients. Although a large proportion agreed that PPC should be delivered at home since the diagnosis of a life-limiting illness, only a few were aware of the suggested referral structure. CONCLUSIONS Most healthcare students were supportive of PPC despite their limited exposure. PPC education on palliative principles, pain management, multidisciplinary approaches, and emotional coping skills is needed and welcomed among students.
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Affiliation(s)
- Kan Yin Wong
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Wai Tak Victor Li
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Pui Yu Yiu
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Tsz Kiu Tong
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - On Hang Ching
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Lok Yin Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Tsz Yau Cheung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Sze Chai Chan
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Hoi Ying Law
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Cheuk Hei Cheng
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
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Forman KR, Thompson-Branch A. Educational Perspectives: Palliative Care Education in Neonatal-Perinatal Medicine Fellowship. Neoreviews 2020; 21:e72-e79. [PMID: 32005717 DOI: 10.1542/neo.21-2-e72] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The neonatal period from birth to less than or equal to 28 days is one of increased risk of death. Congenital anomalies and prematurity are 2 of the most common risk factors for death at this early age. Many of these neonates will die in an intensive care unit, some with full resuscitative efforts being undertaken despite the understanding that these actions are highly unlikely to yield an outcome different from death. Palliative care allows curative therapies to be provided alongside supportive techniques such as enhanced family communication, attention to spirituality and the psychosocial health of the family, management of symptoms other than those specific to the underlying disease process, and enhancing comfort. The American Academy of Pediatrics has set forth recommendations related to pediatric palliative care for the various pediatric subspecialties; however, much of the focus is on disease processes and curing or mitigating various illnesses. Given the high preponderance of death in the neonatal period, neonatal-perinatal medicine training programs should be tasked with generating formal palliative care training. Such training should be geared to providing better care for neonatal patients with a life-limiting or life-altering illness, and better equipping future neonatologists with the tools needed to provide truly comprehensive care for their sickest patients at risk for death and disability. This article serves to review the concept of palliative care in neonates, discuss the paucity of formal education in palliative care, explore the general trend in palliative care education, review various ways in which palliative care education can be formalized, and define metrics of a successful educational program.
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Affiliation(s)
- Katie R Forman
- Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital of Montefiore, Bronx, NY
| | - Alecia Thompson-Branch
- Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital of Montefiore, Bronx, NY
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10
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Perry LM, Hoerger M, Malhotra S, Gerhart JI, Mohile S, Duberstein PR. Development and Validation of the Palliative Care Attitudes Scale (PCAS-9): A Measure of Patient Attitudes Toward Palliative Care. J Pain Symptom Manage 2020; 59:293-301.e8. [PMID: 31539604 DOI: 10.1016/j.jpainsymman.2019.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 11/28/2022]
Abstract
CONTEXT Palliative Care is underutilized, and research has neglected patient-level factors including attitudes that could contribute to avoidance or acceptance of Palliative Care referrals. This may be due in part to a lack of existing measures for this purpose. OBJECTIVES The objective of this study was to develop and validate a nine-item scale measuring patient attitudes toward Palliative Care, comprised of three subscales spanning emotional, cognitive, and behavioral factors. METHODS Data were collected online in three separate waves, targeting individuals with cancer (Sample 1: N = 633; Sample 2: N = 462) or noncancer serious illnesses (Sample 3: N = 225). Participants were recruited using ResearchMatch.org and postings on the web sites, social media pages, and listservs of international health organizations. RESULTS Internal consistency was acceptable for the total scale (α = 0.84) and subscales: emotional (α = 0.84), cognitive (αs = 0.70), and behavioral (α = 0.90). The PCAS-9 was significantly associated with a separate measure of Palliative Care attitudes (ps < 0.001) and a measure of Palliative Care knowledge (ps < 0.004), supporting its construct validity in samples of cancer and noncancer serious illnesses. The scale's psychometric properties, including internal consistency and factor structure, generalized across patient subgroups based on diagnosis, other health characteristics, and demographics. CONCLUSION Findings support the overall reliability, validity, and generalizability of the PCAS-9 in serious illness samples and have implications for increasing Palliative Care utilization via clinical care and future research efforts.
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Affiliation(s)
- Laura M Perry
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA.
| | - Michael Hoerger
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA; Department of Medicine, Section of Hematology and Medical Oncology, Tulane University, New Orleans, Louisiana, USA
| | - Sonia Malhotra
- Department of General Internal Medicine & Geriatrics, Section of Palliative Medicine, Tulane University, New Orleans, Louisiana, USA
| | - James I Gerhart
- Department of Psychology, Central Michigan University, Mount Pleasant, Michigan, USA
| | - Supriya Mohile
- James P. Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Paul R Duberstein
- Department of Health Behavior, Society and Policy, Rutgers University School of Public Health, Piscataway, New Jersey, USA
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Moynihan KM, Snaman JM, Kaye EC, Morrison WE, DeWitt AG, Sacks LD, Thompson JL, Hwang JM, Bailey V, Lafond DA, Wolfe J, Blume ED. Integration of Pediatric Palliative Care Into Cardiac Intensive Care: A Champion-Based Model. Pediatrics 2019; 144:peds.2019-0160. [PMID: 31366685 PMCID: PMC6855829 DOI: 10.1542/peds.2019-0160] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2019] [Indexed: 01/04/2023] Open
Abstract
Integration of pediatric palliative care (PPC) into management of children with serious illness and their families is endorsed as the standard of care. Despite this, timely referral to and integration of PPC into the traditionally cure-oriented cardiac ICU (CICU) remains variable. Despite dramatic declines in mortality in pediatric cardiac disease, key challenges confront the CICU community. Given increasing comorbidities, technological dependence, lengthy recurrent hospitalizations, and interventions risking significant morbidity, many patients in the CICU would benefit from PPC involvement across the illness trajectory. Current PPC delivery models have inherent disadvantages, insufficiently address the unique aspects of the CICU setting, place significant burden on subspecialty PPC teams, and fail to use CICU clinician skill sets. We therefore propose a novel conceptual framework for PPC-CICU integration based on literature review and expert interdisciplinary, multi-institutional consensus-building. This model uses interdisciplinary CICU-based champions who receive additional PPC training through courses and subspecialty rotations. PPC champions strengthen CICU PPC provision by (1) leading PPC-specific educational training of CICU staff; (2) liaising between CICU and PPC, improving use of support staff and encouraging earlier subspecialty PPC involvement in complex patients' management; and (3) developing and implementing quality improvement initiatives and CICU-specific PPC protocols. Our PPC-CICU integration model is designed for adaptability within institutional, cultural, financial, and logistic constraints, with potential applications in other pediatric settings, including ICUs. Although the PPC champion framework offers several unique advantages, barriers to implementation are anticipated and additional research is needed to investigate the model's feasibility, acceptability, and efficacy.
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Affiliation(s)
- Katie M. Moynihan
- Division of Cardiovascular Critical Care, Department of Cardiology, Boston Children’s Hospital Boston, Massachusetts;,Department of Pediatrics, Medical School, Harvard University, Boston, Massachusetts
| | - Jennifer M. Snaman
- Department of Pediatrics, Medical School, Harvard University, Boston, Massachusetts;,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Erica C. Kaye
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Wynne E. Morrison
- Pediatric Advanced Care Team, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; Departments of,Anesthesiology and Critical Care and
| | - Aaron G. DeWitt
- Pediatric Advanced Care Team, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; Departments of,Anesthesiology and Critical Care and
| | - Loren D. Sacks
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Stanford, California
| | - Jess L. Thompson
- Department of Cardiothoracic Surgery, Children’s Heart Center, University of Oklahoma, Oklahoma City, Oklahoma; and
| | - Jennifer M. Hwang
- Pediatric Advanced Care Team, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; Departments of,Pediatrics, Perelman School of Medicine, The University of Pennsylvania and Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Valerie Bailey
- Division of Cardiovascular Critical Care, Department of Cardiology, Boston Children’s Hospital Boston, Massachusetts
| | - Deborah A. Lafond
- PANDA Palliative Care Team, Children’s National and School of Medicine, The George Washington University, Washington, District of Columbia
| | - Joanne Wolfe
- Department of Pediatrics, Medical School, Harvard University, Boston, Massachusetts;,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Elizabeth D. Blume
- Division of Cardiovascular Critical Care, Department of Cardiology, Boston Children’s Hospital Boston, Massachusetts;,Department of Pediatrics, Medical School, Harvard University, Boston, Massachusetts
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12
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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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13
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Carroll T, Weisbrod N, O'Connor A, Quill T. Primary Palliative Care Education: A Pilot Survey. Am J Hosp Palliat Care 2017; 35:565-569. [PMID: 28782375 DOI: 10.1177/1049909117723618] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The demand for palliative services is outpacing the availability of specialist palliative care clinicians. One strategy to fill this gap is to improve "primary palliative care" skills and knowledge of all clinicians who care for seriously ill patients. Previous educational efforts have shown mixed results, and one possible explanation is unrecognized discordance of educational goals between those offering education and potential primary palliative care learners. The article describes the results and feasibility of a needs assessment survey comparing interest in palliative care education topics and settings among both palliative care specialists (PCS) and nonpalliative care specialists (NPCS). This is the first attempt to measure the perceived importance of primary palliative care topics and preferences about learning settings from the perspectives of both NPCS and PCS. The results suggest substantial areas of both concordant and discordant opinions with respect to educational topics and learning settings. Such data are essential to guide primary palliative care educational efforts. Future work will be needed to determine whether these results are consistent across diverse health systems and what variables influence educational preferences.
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Affiliation(s)
- Thomas Carroll
- 1 Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Neal Weisbrod
- 1 Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Alec O'Connor
- 1 Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Timothy Quill
- 1 Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
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14
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Brock KE, Cohen HJ, Sourkes BM, Good JJ, Halamek LP. Training Pediatric Fellows in Palliative Care: A Pilot Comparison of Simulation Training and Didactic Education. J Palliat Med 2017; 20:1074-1084. [PMID: 28436742 DOI: 10.1089/jpm.2016.0556] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pediatric fellows receive little palliative care (PC) education and have few opportunities to practice communication skills. OBJECTIVE In this pilot study, we assessed (1) the relative effectiveness of simulation-based versus didactic education, (2) communication skill retention, and (3) effect on PC consultation rates. DESIGN Thirty-five pediatric fellows in cardiology, critical care, hematology/oncology, and neonatology at two institutions enrolled: 17 in the intervention (simulation-based) group (single institution) and 18 in the control (didactic education) group (second institution). Intervention group participants participated in a two-day program over three months (three simulations and videotaped PC panel). Control group participants received written education designed to be similar in content and time. MEASUREMENTS (1) Self-assessment questionnaires were completed at baseline, post-intervention and three months; mean between-group differences for each outcome measure were assessed. (2) External reviewers rated simulation-group encounters on nine communication domains. Within-group changes over time were assessed. (3) The simulation-based site's PC consultations were compared in the six months pre- and post-intervention. RESULTS Compared to the control group, participants in the intervention group improved in self-efficacy (p = 0.003) and perceived adequacy of medical education (p < 0.001), but not knowledge (p = 0.20). Reviewers noted nonsustained improvement in four domains: relationship building (p = 0.01), opening discussion (p = 0.03), gathering information (p = 0.01), and communicating accurate information (p = 0.04). PC consultation rate increased 64%, an improvement when normalized to average daily census (p = 0.04). CONCLUSIONS This simulation-based curriculum is an effective method for improving PC comfort, education, and consults. More frequent practice is likely needed to lead to sustained improvements in communication competence.
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Affiliation(s)
- Katharine E Brock
- 1 Division of Pediatric Hematology/Oncology, Emory University , Atlanta, Georgia .,2 Aflac Cancer & Blood Disorders Center , Children's Healthcare of Atlanta, Atlanta, Georgia .,3 Pediatric Palliative Care, Children's Healthcare of Atlanta , Atlanta, Georgia
| | - Harvey J Cohen
- 4 Department of Pediatrics, Stanford University , Stanford, California.,5 Division of Hematology/Oncology, Stanford University , Stanford, California
| | - Barbara M Sourkes
- 4 Department of Pediatrics, Stanford University , Stanford, California.,6 Division of Critical Care Medicine, Stanford University , Stanford, California
| | - Julie J Good
- 4 Department of Pediatrics, Stanford University , Stanford, California.,7 Division of Anesthesiology, Perioperative and Pain Medicine, Stanford University , Stanford, California
| | - Louis P Halamek
- 4 Department of Pediatrics, Stanford University , Stanford, California.,8 Division of Neonatal and Developmental Medicine, Stanford University , Stanford, California.,9 Center for Advanced Pediatric and Perinatal Education, Stanford University , Stanford, California
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