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Dolan S, Nowell L. Interprofessional Education Opportunities for Health Care Educators in the Practice Setting: An Integrative Review. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2024:00005141-990000000-00127. [PMID: 39190560 DOI: 10.1097/ceh.0000000000000573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/29/2024]
Abstract
INTRODUCTION Health care educators in the practice setting are responsible for providing education to frontline staff and require knowledge and skills to interact with interprofessional health care providers and teach content in an effective way. Interprofessional education opportunities for health care educators in the practice setting may be helpful in preparing educators to meet the needs of frontline staff, yet the extant state of literature on this topic has not been recently synthesized. In this integrative review, we aimed to explore what is known about interprofessional education opportunities offered to health care educators who are responsible for educating other health care professionals in practice settings and assess how these education opportunities were described and evaluated in the literature. METHODS We conducted an integrative literature review following the methodology put forth by Toronto and Remington. RESULTS Of the 3690 publications identified, 30 met our inclusion criteria. Overall, the publications lacked rigorous methodology. Education interventions varied in content, duration, and teaching strategies. Key findings were identified: (1) educator satisfaction and content relevance, (2) impact on knowledge, skills, and confidence, (3) impact on teaching practice, (4) impact on clinical practice, (5) impact on interprofessional competencies and attitudes, (6) challenges to implementing interprofessional education opportunities, and (7) facilitators to implementing interprofessional education opportunities. DISCUSSION Although interprofessional education opportunities for health care educators in the practice setting may be beneficial to educators and the frontline staff they serve, more rigorous research is needed to understand how these opportunities can influence teaching and clinical practice.
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Affiliation(s)
- Sara Dolan
- Dr. Dolan: Postdoctoral Scholar, Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada. Dr. Nowell: Associate Professor, Assistant Dean, Graduate Programs, Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
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Barnbrock A, Schäfer K, Stursberg J, Siebald B, Graf N, Mücke U, Schneider DT, Bochennek K, Füller M. Committed Lone Fighters And Group Experiences: An International Survey On Pediatric Hematology And Oncology Training In German-Speaking Countries. KLINISCHE PADIATRIE 2024. [PMID: 38428466 DOI: 10.1055/a-2260-4374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
INTRODUCTION In German-speaking countries children with cancer are treated in about 70 hospitals. While national and European curricula for pediatric oncology and hematology (POH) have been developed, little is known, how far these curricula have been implemented into daily training and what topics are deemed urgent by instructors. METHODS AND MATERIALS In 2022 the Didactics and Educational working party of the German Pediatric Hematology/Oncology Society conducted a survey plus interview by phone call on local educational conditions in POH and needs of educators. RESULTS Thirty-two (45%) POH centers answered the questionary, half have appointed persons overseeing the training. A wide range educational scenarios were described in some centers. Trainees identified urgent needs in areas such as hybrid education and demanded training workshops on specific topics and intensified networking and a general curriculum implemented into daily care as mandatory. CONCLUSION This is the first survey on educational issues in POH in German speaking centers, describing the current situation before and under pandemic conditions. Great individual efforts have already been achieved by dedicated teachers. A comprehensive training program in POH is still missing, which translates the national curriculum into daily practice, while improving networking and balancing the resources of the individual centers.
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Affiliation(s)
- Anke Barnbrock
- Centre for Paediatrics and Adolescent Medicine, Pediatric Hematology and Oncology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Kristine Schäfer
- Pediatric Hematology and Oncology, University Hospital Giessen, Giessen, Germany
| | - Jana Stursberg
- Pediatric Hematology and Oncology, Ulm University Hospital, Ulm, Germany
| | - Benjamin Siebald
- Centre for Paediatrics and Adolescent Medicine, Pediatric Hematology and Oncology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Norbert Graf
- Pediatric Hematology and Oncology, Saarland University Hospital, Homburg/Saar, Germany
| | - Urs Mücke
- Pediatric Hematology and Oncology, Hannover Medical School Centre for Paediatrics and Adolescent Medicine, Hannover, Germany
| | - Dominik T Schneider
- Centre for Paediatrics and Adolescent Medicine, Pediatric Hematology and Oncology, Hospital Dortmund, Dortmund, Germany
| | - Konrad Bochennek
- Centre for Paediatrics and Adolescent Medicine, Pediatric Hematology and Oncology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Miriam Füller
- Bone marrow transplantation and Pediatric Hematology and Oncology, University Hospital Münster, Munster, Germany
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Lyons KA, Middleton AA, Farley AA, Henderson NE, Peterson EB. End-of-Life Care Education in Pediatric Critical Care Medicine Fellowship Programs: Exploring Fellow and Program Director Perspectives. J Palliat Med 2023; 26:1217-1224. [PMID: 37093219 DOI: 10.1089/jpm.2022.0397] [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: 04/25/2023] Open
Abstract
Background/Objectives: The aim of this study is to describe the current state of end-of-life (EOL) care education within pediatric critical care medicine (PCCM) fellowship programs and explore potential differences in beliefs on EOL care education between program directors (PDs) and fellows. Design: A mixed-methods study based on data obtained through a nationally distributed, web-based cross-sectional survey of PCCM fellowship PDs and PCCM fellows was performed. Setting: Accreditation Council for Graduate Medical Education (ACGME)-accredited PCCM fellowships in the United States. Subjects: PCCM fellows and PDs participated in this study. Measurements and Results: The total number of survey respondents was 124 (94/654 fellows and 30/96 PDs), representing 39% of ACGME-accredited PCCM programs. Bedside teaching and lecture-based modalities were the most commonly used methods to teach EOL care. Most fellows and PDs reported a perceived need for additional EOL education within their respective training programs (fellows 91%, n = 86/94; PDs 67%, n = 20/30). A thematic analysis of curriculum structure questions revealed significant similarities between PDs and fellows, including the perceived need for education in communication, medical management, and cultural awareness. Dealing with uncertainty and resiliency were identified as themes among PDs only, and emotional/moral and legal issues were identified as themes solely by fellows. Conclusions: Our study describes the current state of EOL care education within a sample of PCCM fellowship programs. We highlight the perceived need for additional EOL education and identify areas within EOL care that deserve more focus by PCCM fellows and PDs. Future studies with focus on EOL curriculum development in PCCM EOL training are needed.
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Affiliation(s)
- Kelly A Lyons
- Division of Pediatric Critical Care, Department of Pediatrics, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Kentucky, USA
| | - Alyssa A Middleton
- Doctor of Social Work Department, Kent School of Social Work, University of Louisville, Louisville, Kentucky, USA
| | - Alyssa A Farley
- Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Natalie E Henderson
- Division of Pediatric Critical Care, Department of Pediatrics, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Kentucky, USA
| | - Eleanor B Peterson
- Division of Pediatric Critical Care, Department of Pediatrics, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Kentucky, USA
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Kennedy M, Loftus M, Lafferty T, Hilliard C, Reaper-Reynolds S, O'Donnell C. Reimagining a children's palliative care educational programme for registered nurses in response to the COVID-19 pandemic. NURSE EDUCATION TODAY 2022; 119:105569. [PMID: 36155211 PMCID: PMC9487166 DOI: 10.1016/j.nedt.2022.105569] [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: 05/29/2022] [Revised: 09/01/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Children with life-limiting conditions are a unique population with multiple health and social care needs. Key literature indicates the need for education to support registered nurses providing care, including palliative care, to these children. In response to the COVID-19 pandemic, a palliative care programme was converted to an online programme, adopting a blended approach between national and regional facilitators. OBJECTIVES To assess nurses' satisfaction with a re-designed palliative care programme centred around the care of children with life-limiting conditions, including their perceptions of the online format. DESIGN AND METHODS A descriptive correlational design and online survey was used to explore the participants' perception of the content and online delivery of the Care of the Child with a Life-Limiting Condition programme. Nine sessions, comprised of five national and four regional webinars, were delivered. RESULTS Attendees registered (n = 169) from throughout the Republic of Ireland, with 130 attending all webinars. Attendees stated online delivery of education increased their accessibility to highly qualified experts. The short, concise nature of sessions was well received. Online delivery and recorded sessions contributed to convenience with the ability to access and process information in attendees' own time being welcomed. However, the negative impact of losing face-to-face interactions was noted, including the opportunity to build relationships with colleagues caring for children with life-limiting conditions. CONCLUSIONS Results suggest that the redesigned online programme contributed to participants' knowledge, encouraged participation and increased accessibility. An e-Learning model enables specialised education to be more equitable and accessible, ensuring regional areas are not disadvantaged due to geographical remoteness from tertiary educational centres. However, the lack of face-to-face contact was acknowledged as a hindrance to socialisation and networking. When developing future programmes, focus should be put on creating opportunities for networking and social development to compensate for the lack of face-to-face contact.
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Affiliation(s)
- Martina Kennedy
- School of Nursing, Midwifery and Health Systems, Health Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Mairéad Loftus
- Centre of Nurse & Midwifery Education Mayo/Roscommon, Castlebar, Co. Mayo, Ireland
| | - Tricia Lafferty
- Centre of Nursing & Midwifery Education Donegal, Letterkenny, Co. Donegal, Ireland
| | - Carol Hilliard
- Children's Health Ireland (CHI) at Crumlin, Crumlin, Dublin 12, Ireland
| | | | - Carmel O'Donnell
- Centre of Children's Nurse Education, Children's Health Irealand (CHI), Crumlin, Dublin 12, Ireland
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McNeil MJ, Ehrlich B, Yakimkova T, Wang H, Mishkova V, Bezler Z, Kumirova E, Madni A, Movsisyan N, Williams K, Baizakova B, Borisevich M, Chatman G, Erimbetova I, Quintero XG, Golban R, Kirby B, Nunez P, Ranadive R, Sakhar N, Sonnenfelt J, Volkova A, Moreira D, Friedrichsdorf SJ, Wolfe J, Remke S, Hauser J, Devidas M, Baker JN, Agulnik A. Regional adaptation of the education in palliative and end-of-life Care Pediatrics (EPEC-Pediatrics) curriculum in Eurasia. Cancer Med 2022; 12:3657-3669. [PMID: 36073348 PMCID: PMC9939085 DOI: 10.1002/cam4.5213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/14/2022] [Accepted: 08/24/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Pediatric palliative care (PPC) is a priority to improve pediatric hematology oncology (PHO) care in Eurasia. However, there are limited regional opportunities for PPC education. We describe the adaptation and implementation of a bilingual end-user Education in Palliative and End-of-Life Care (EPEC)-Pediatrics course for PHO clinicians in Eurasia. METHODS Due to COVID-19, this course was delivered virtually, consisting of prerecorded, asynchronous lectures, and a bilingual workshop with interactive lectures and small group sessions. A pre-postcourse design was used to evaluate the knowledge acquisition of the participants including their knowledge alignment with World Health Organization (WHO) guidance, ideal timing of palliative care, and comfort in providing palliative care to their patients. Questions were mostly quantitative with multiple choice or Likert scale options, supplemented by free-text responses. RESULTS A total of 44 (76%) participants from 14 countries completed all components of the course including pre- and postcourse assessments. Participant alignment with WHO guidance improved from 75% in the pre- to 90% in the postcourse assessments (p < 0.001). After participation, 93% felt more confident controlling the suffering of children at the end of life, 91% felt more confident in prescribing opioids and managing pain, and 98% better understood how to hold difficult conversations with patients and families. Most participants (98%) stated that they will change their clinical practice based on the skills and knowledge gained in this course. CONCLUSIONS We present a successful regional adaptation of the EPEC-Pediatrics curriculum, including novel delivery of course content via a virtual bilingual format. This course resulted in significant improvement in participant attitudes and knowledge of PPC along with an understanding of the ideal timing of palliative care consultation and comfort in providing PPC to children with cancer. We plan to incorporate participant feedback to improve the course and repeat it annually to improve access to high-quality palliative care education for PHO clinicians in Eurasia.
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Affiliation(s)
| | - Bella Ehrlich
- St. Jude Children's Research HospitalMemphisTennesseeUSA,Warren Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | | | - Huiqi Wang
- St. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Volha Mishkova
- Belarusian Research Center for Pediatric OncologyHematology and ImmunologyMinskBelarus
| | - Zhanna Bezler
- Belarusian Clinical Center of Palliative Care for ChildrenMinskBelarus
| | - Ella Kumirova
- Dmitry Rogachev National Research Center of Pediatric HematologyOncology and ImmunologyMoscowRussia,Russian Scientific Center of Roengenology and RadiologyMoscowRussia,Pyrogov Medical UniversityMoscowRussia,Morozovskaya Children's City Clinical HospitalMoscowRussia,N.N. Blokhin National Medical Research Center of OncologyMoscowRussia
| | - Arshia Madni
- St. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Narine Movsisyan
- Yerevan State Medical University After Mkhitar HeratsiYerevanArmenia
| | - Karen Williams
- St. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Baglan Baizakova
- George Washington UniversityThe Milken Institute School of Public HealthWashington, District of ColumbiaUSA
| | - Marina Borisevich
- Belarusian Research Center for Pediatric OncologyHematology and ImmunologyMinskBelarus
| | | | - Indira Erimbetova
- The Republican Center for Hematology and Blood TransfusionTashkentUzbekistan
| | | | - Rodica Golban
- Institute of Oncology of Republic of MoldovaMoldovaChisinau
| | - Brandi Kirby
- St. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Paola Nunez
- St. Jude Children's Research HospitalMemphisTennesseeUSA
| | | | - Nadezhda Sakhar
- Republican Scientific and Practical Center for Pediatric SurgeryMinskBelarus
| | | | - Alisa Volkova
- Raisa Gorbacheva Memorial Research Institute for Pediatric OncologyHematology and TransplantationSt. PetersburgRussia
| | - Daniel Moreira
- St. Jude Children's Research HospitalMemphisTennesseeUSA
| | | | - Joanne Wolfe
- Dana Farber Cancer InstituteBostonMassachusettsUSA
| | - Stacy Remke
- University of MinnesotaMinneapolisMinnesotaUSA
| | | | | | | | - Asya Agulnik
- St. Jude Children's Research HospitalMemphisTennesseeUSA
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Daubman BR, Pérez-Cruz PE, Leiva O, Wong AW, Stoltenberg M. Furthering Palliative Care Training in Latin America: Development and Assessment of an Advanced Diploma Course in Palliative Care in Chile. J Pain Symptom Manage 2022; 64:128-136. [PMID: 35523387 DOI: 10.1016/j.jpainsymman.2022.04.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/16/2022] [Accepted: 04/25/2022] [Indexed: 11/16/2022]
Abstract
CONTEXT The vast majority of people with serious health-related suffering in low- and middle-income countries lack access to palliative care (PC). In Latin America, this shortage is critical, and PC education is greatly needed. OBJECTIVES This study aims to assess the effects of an advanced PC diploma course in Chile through assessment of participants' satisfaction, knowledge, behavior, and self-efficacy. METHODS We developed and implemented a 12-day, hybrid-setting, advanced PC diploma course for Latin American clinicians and collected and analyzed pre course, immediate post course, and 6-month post course quantitative and qualitative data on satisfaction, knowledge, behaviors, and self-efficacy. RESULTS Thirteen Latin American doctors participated in this advanced PC diploma course. Overall knowledge and self-efficacy increased post course. One hundred percent of participants described the course as "very high quality" or "high quality," described the course's teaching methods as "very easy to understand" or "easy to understand," and ranked role-play as a "very useful" tool. CONCLUSION There is a critical shortage of PC in Latin America where PC education is greatly needed. The lessons learned from this pilot advanced PC diploma course will inform further PC educational development in Latin America. The results of our course assessments show that an advanced diploma course can increase participants' PC knowledge, behaviors, and self-efficacy with a goal of leveraging the Train the Trainer model to increase PC educational leadership and enable training at participants' home institutions.
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Affiliation(s)
- Bethany-Rose Daubman
- Division of Palliative Care and Geriatrics (B.R.D., M.S.), Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School (B.R.D., M.S.), Boston, Massachusetts, USA
| | - Pedro E Pérez-Cruz
- Programa Medicina Paliativa y Cuidados Continuos (P.E.P.C., O.L.), Departamento de Medicina Interna - Facultad de Medicina - Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ofelia Leiva
- Programa Medicina Paliativa y Cuidados Continuos (P.E.P.C., O.L.), Departamento de Medicina Interna - Facultad de Medicina - Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Allen W Wong
- School of Sciences and Humanities (A.W.W.), Wentworth Institute of Technology, Boston, Massachusetts, USA
| | - Mark Stoltenberg
- Division of Palliative Care and Geriatrics (B.R.D., M.S.), Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School (B.R.D., M.S.), Boston, Massachusetts, USA
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Whitsett MP, Ufere NN, Patel A, Shea JA, Jones CA, Fix OK, Serper M. Palliative care experience and perceived gaps in training among transplant hepatology fellows: A national survey. Hepatol Commun 2022; 6:1680-1688. [PMID: 35411683 PMCID: PMC9234628 DOI: 10.1002/hep4.1939] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/25/2022] [Accepted: 02/17/2022] [Indexed: 11/20/2022] Open
Abstract
Despite the likely benefits of palliative care (PC) for patients with cirrhosis, physician experiences and perspectives about best practices are variable. We aimed to assess PC experience and gaps in training among transplant hepatology fellows. We conducted a national survey of all transplant hepatology fellows enrolled in accredited fellowship programs during the 2020-2021 academic year. We assessed the frequency of PC provision and comfort with physical and psychological symptom management, psychosocial care, communication skills, advance care planning, and end-of-life care. A total of 45 of 56 (79%) of transplant hepatology fellows responded to the survey; 50% (n = 22) were female. Most trained at centers performing over 100 transplants per year (67%, n = 29) distributed evenly across geographic regions. Most fellows (69%, n = 31) had a PC or hospice care rotation during residency, and 42% (n = 19) of fellows received education in PC during transplant hepatology fellowship. Fellows reported feeling moderately to very comfortable with communication skills such as breaking bad news (93%, n = 41) and leading family meetings (75%, n = 33), but nearly one-third (30%, n = 13) reported feeling not very or not at all comfortable assessing and managing anxiety and depression (30%, n = 13) and spiritual distress (34%, n = 15). Nearly one-quarter (22%, n = 10) had never discussed or documented advance care plans during fellowship. Fellows wished to receive future instruction on the assessment and management of physical symptoms (68%, n = 30) and anxiety and depression (64%, n = 28). Conclusion: Our survey highlights gaps in PC experience and education during transplant hepatology fellowship, lack of comfort in managing psychological distress and advance care planning, and desire to improve skills, particularly in symptom management. Future studies should investigate how to enhance transplant hepatology competencies in these PC domains and whether this impacts clinical care, advance care planning, or patient experience.
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Affiliation(s)
- Maureen P Whitsett
- Division of Gastroenterology and HepatologyCleveland ClinicClevelandOhioUSA
| | - Nneka N Ufere
- Liver CenterGastrointestinal UnitMassachusetts General HospitalBostonMassachusettsUSA
| | - Arpan Patel
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of MedicineDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA.,Veterans Affairs Greater Los Angeles Healthcare SystemLos AngelesCaliforniaUSA
| | - Judy A Shea
- Division of General Internal MedicineDepartment of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Christopher A Jones
- Department of Internal MedicineDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Oren K Fix
- Division of Gastroenterology and HepatologyUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Marina Serper
- Division of Gastroenterology and HepatologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA.,Corporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA.,Leonard Davis InstituteUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
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García-Quintero X, Claros-Hulbert A, Tello-Cajiao ME, Bolaños-Lopez JE, Cuervo-Suárez MI, Durán MGG, Gómez-García W, McNeil M, Baker JN. Using EmPalPed-An Educational Toolkit on Essential Messages in Palliative Care and Pain Management in Children-As a Strategy to Promote Pediatric Palliative Care. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9060838. [PMID: 35740775 PMCID: PMC9221893 DOI: 10.3390/children9060838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/23/2022] [Accepted: 04/15/2022] [Indexed: 11/16/2022]
Abstract
Background: Most children needing palliative care (PC) live in low- and middle-income countries. In Colombia, pediatric palliative care (PPC) knowledge among healthcare professionals (HCPs) is lacking as PPC is not included in the educational curricula of healthcare programs. Therefore, specific training that improves knowledge of HCPs and access to PC for children and their families is needed. To address this gap, we organized and conducted the Essential Messages in Palliative Care and Pain Management in Children (EmPalPed), an educational toolkit to increase awareness and promote essential knowledge in PPC for low- and middle-income countries. Methodology: The EmPalPed toolkit consisted of a 5-h virtual workshop with small working groups of HCPs caring for children with life-threatening conditions such as cancer. The toolkit was organized along five key domains: (1) PC as it relates to the concept of quality of life (QoL), (2) effective communication, (3) addressing pain management as a top priority, (4) providing end-of-life care, and (5) access to high-quality PC as a fundamental human right. The workshop activities included different educational strategies and tools (e.g., a pocket guide for pain assessment and management, a PPC booklet, a quick guide for communicating bad news, role playing, and discussions of clinical cases). Results: A total of 145 HCPs from 22 centers were trained. The post-test analysis for HCPs showed that attitude and knowledge about communication (p < 0.001), pain assessment (p < 0.001), first-line opioid of choice in children (p < 0.001), and palliative sedation (p < 0.001) had positive and statistically significant changes from the pre-test analysis. Discussion: This study supported the notion that the EmPalPed educational toolkit is an effective mechanism for raising awareness regarding PPC as well as providing training in many of the key aspects of PPC. The EmPalPed training approach should be studied beyond this setting, and the impact should be measured longitudinally.
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Affiliation(s)
- Ximena García-Quintero
- Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cali 760032, Colombia;
- Division of Quality of Life and Palliative Care, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, MS #260, Memphis, TN 38105, USA; (J.N.B.); (M.M.)
- Correspondence: ; Tel.: +1-(954)-290-1804
| | - Angélica Claros-Hulbert
- Faculty of Health Sciences, Universidad de la Sabana, Chia 250001, Colombia;
- Palliative Care Department, Instituto Nacional de Cancerología, Bogotá 111511, Colombia
| | | | - Jhon Edwar Bolaños-Lopez
- Dirección de Investigación y Desarrollo, Centro de Biociencias, Seguros SURA Colombia, Medellín 050021, Colombia;
| | - María Isabel Cuervo-Suárez
- Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cali 760032, Colombia;
- Faculty of Health Sciences Department, Clinical Medical Science, Universidad Icesi, Cali 760031, Colombia
| | - Martha Gabriela García Durán
- Psycho-Oncology Service, Hospital Pediátrico de Sinaloa “Dr. Rigoberto Aguilar Pico”, Culiacán 80200, Sinaloa, Mexico;
| | - Wendy Gómez-García
- Dr. Robert Reid Cabral Children’s Hospital, Santo Domingo 10107, Dominican Republic;
| | - Michael McNeil
- Division of Quality of Life and Palliative Care, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, MS #260, Memphis, TN 38105, USA; (J.N.B.); (M.M.)
| | - Justin N. Baker
- Division of Quality of Life and Palliative Care, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, MS #260, Memphis, TN 38105, USA; (J.N.B.); (M.M.)
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Postier AC, Wolfe J, Hauser J, Remke SS, Baker JN, Kolste A, Dussel V, Bernadá M, Widger K, Rapoport A, Drake R, Chong PH, Friedrichsdorf SJ. Education in Palliative and End-of-Life Care-Pediatrics: Curriculum Use and Dissemination. J Pain Symptom Manage 2022; 63:349-358. [PMID: 34896279 DOI: 10.1016/j.jpainsymman.2021.11.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/19/2021] [Accepted: 11/24/2021] [Indexed: 10/19/2022]
Abstract
CONTEXT The majority of seriously ill children do not have access to specialist pediatric palliative care (PPC) services nor to clinicians trained in primary PPC. The Education in Palliative and End-of-Life Care (EPEC)-Pediatrics curriculum and dissemination project was created in 2011 in response to this widespread education and training need. Since its implementation, EPEC-Pediatrics has evolved and has been disseminated worldwide. OBJECTIVES Assessment of past EPEC-Pediatrics participants' ("Trainers") self-reported PPC knowledge, attitudes, and skills; use of the curriculum in teaching; and feedback about the program's utility and future direction. METHODS From 2011 to 2019 survey of EPEC-Pediatrics past conference participants, using descriptive and content analyses. RESULTS About 172 of 786 (22% response rate) EPEC-Pediatrics past participants from 59 countries across six continents completed the survey. Trainers, including Master Facilitators (MFs), used the curriculum mostly to teach interdisciplinary clinicians and reported improvement in teaching ability as well as in attitude, knowledge, and skills (AKS) in two core domains of PPC: communication and pain and symptom management. The most frequently taught modules were about multimodal management of distressing symptoms. Trainers suggested adding new content to the current curriculum and further expansion in low-medium income countries. Most (71%) reported improvements in the clinical care of children with serious illnesses at their own institutions. CONCLUSION EPEC-Pediatrics is a successful curriculum and dissemination project that improves participants' self-reported teaching skills and AKS's in many PPC core domains. Participating clinicians not only taught and disseminated the curriculum content, they also reported improvement in the clinical care of children with serious illness.
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Affiliation(s)
- Andrea C Postier
- University of California San Francisco Department of Pediatrics, Center for Pediatric Pain, Palliative and Integrative Medicine (A.C.P., S.J.F.), UCSF Benioff Children's Hospital, San Francisco, California, USA.
| | - Joanne Wolfe
- Dana-Farber Cancer Institute (J.W.), Boston Children's Hospital, Boston, Massachusetts, USA
| | - Joshua Hauser
- Department of Medicine (Palliative Medicine) (J.H.), Northwestern Feinberg School of Medicine, Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Stacy S Remke
- University of Minnesota School of Social Work (S.S.R.), St. Paul, Minnesota, USA
| | - Justin N Baker
- Division of Quality of Life and Palliative Care (J.N.B.), St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Alison Kolste
- Children's Hospitals and Clinics of Minnesota (A.K.), Minneapolis, Minnesota, USA
| | - Verónica Dussel
- Center for Research and Implementation in Palliative Care (V.D.), Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina; Dana-Farber Cancer Institute/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA
| | - Mercedes Bernadá
- School of Medicine, Universidad de la República (M.B.), Montevideo, Uruguay
| | - Kimberley Widger
- Lawrence S. Bloomberg Faculty of Nursing (K.W.), University of Toronto, Paediatric Advanced Care Team (PACT), The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Adam Rapoport
- Paediatric Advanced Care Team (PACT) (A.R.), The Hospital for Sick Children, Emily's House Children's Hospice, Departments of Paediatrics and Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ross Drake
- Palliative Care and Pain Medicine (R.D.), Starship Children's Health, Auckland, New Zealand
| | | | - Stefan J Friedrichsdorf
- University of California San Francisco Department of Pediatrics, Center for Pediatric Pain, Palliative and Integrative Medicine (A.C.P., S.J.F.), UCSF Benioff Children's Hospital, San Francisco, California, USA
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10
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Torres LM, Camarena AE, Martin A, Shah R. Examining Implementation Outcomes of Sit Down and Play, a Primary Care-Based Intervention, in a Large Urban Primary Care Clinic. Matern Child Health J 2021; 25:1744-1756. [PMID: 34415470 DOI: 10.1007/s10995-021-03210-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Economical, operational, and employment strains present challenges for widespread implementation of parent-directed interventions. We designed Sit Down and Play (SDP) with the aim of creating a brief primary care-based program that encourages positive parenting practices through take-home play activities. To develop a sustainable model of implementation in real-world settings, we explored the use of university student volunteers as a potential solution for employment strains. Guided by Proctor and colleagues' implementation outcome framework, this study focused on understanding the following implementation outcomes: acceptability, feasibility, fidelity, and service penetration. Exploratory analysis on the limited-efficacy of the program on parental behavior was also assessed. METHODS Student facilitators were trained utilizing a train-the-trainer model. During the study period, facilitators delivered SDP to caregivers attending their well-child visits (WCVs) in a primary care clinic serving predominantly low-income families. Implementation data was gathered from clinic records, student facilitator surveys, and caregiver surveys. RESULTS Student facilitators delivered SDP interventions to 99/146 (67.8%) eligible families. Caregivers overwhelmingly found the program helpful (M = 4.70, SD = 0.82), enjoyable (M = 4.88, SD = 0.32), and were highly satisfied with individuals who delivered it (M = 4.97, SD = 0.16). Student facilitators successfully delivered the program with high fidelity. CONCLUSIONS FOR PRACTICE Implementation findings suggest that delivery of SDP by student volunteers combined with the use of a train-the-trainer model is a feasible model to integrate strategies that support positive parenting behaviors into existing systems, such as the primary care setting. This study yields promising results that suggest the benefit of utilizing university partnerships with healthcare settings for wider dissemination and adaptations for other subgroups and contexts.
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Affiliation(s)
- Luz M Torres
- Department of Psychology, University of Illinois of Chicago, 1007 W Harrison St., 1009 BSB, MC 285, Chicago, IL, 60607, USA.
| | - Andrea E Camarena
- School of Medicine, Meharry Medical College, 1005 Dr DB Todd Jr Blvd, Nashville, TN, 37208, USA
| | - Aleah Martin
- Department of Women, Children and Family Nursing, Rush University, 600 S. Paulina St, Chicago, IL, 60612, USA
| | - Reshma Shah
- Department of Pediatrics, University of Illinois At Chicago, 840 S Wood St, Chicago, IL, 60612, USA
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11
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Lalloo C, Osei-Twum JA, Rapoport A, Vadeboncoeur C, Weingarten K, Veldhuijzen van Zanten S, Widger K, Stinson J. Pediatric Project ECHO ®: A Virtual Community of Practice to Improve Palliative Care Knowledge and Self-Efficacy among Interprofessional Health Care Providers. J Palliat Med 2020; 24:1036-1044. [PMID: 33326309 PMCID: PMC8215401 DOI: 10.1089/jpm.2020.0496] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: Health care providers (HCPs) require ongoing training and mentorship to fully appreciate the palliative care needs of children. Project ECHO® (Extension for Community Healthcare Outcomes) is a model for delivering technology-enabled interprofessional education and cultivating a community of practice among HCPs who care for children with life-limiting illness. Objectives: To develop, implement, and evaluate the Project ECHO model within the pediatric palliative care (PPC) context. Specific objectives were to evaluate (1) participation levels, (2) program acceptability, (3) HCP knowledge changes, (4) HCP self-efficacy changes, and (5) perceived practice changes after six months. Intervention: An interprofessional PPC curriculum was informed by a needs assessment. The curriculum was delivered through monthly virtual 90-minute TeleECHO sessions (didactic presentation and case-based learning) from January 2018 to December 2019. The program was freely available to all HCPs wishing to participate. Design: A mixed-methods design with repeat measures was used. Surveys were distributed at baseline and six months to assess outcomes using 7-point Likert scales. Descriptive and inferential statistical analyses were conducted. The study was approved by the Research Ethics Board at the Hospital for Sick Children. Results: Twenty-four TeleECHO sessions were completed with a mean of 32 ± 12.5 attendees. Acceptability scores (n = 43) ranged from 5.1 ± 1.1 to 6.5 ± 0.6. HCPs reported improvements in knowledge and self-efficacy across most topics (11 out of 12) and skills (8 out of 10) with demonstrated statistical significance (p < 0.05). Most participants reported positive practice impacts, including enhanced ability to provide PPC in their practice. Conclusion: Project ECHO is a feasible and impactful model for fostering a virtual PPC-focused community of practice among interprofessional HCPs.
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Affiliation(s)
- Chitra Lalloo
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Address correspondence to: Chitra Lalloo, BHSc, PhD, Child Health Evaluative Sciences, The Hospital for Sick Children, 686 Bay Street, Toronto, Ontario M5G 0A4, Canada
| | - Jo-Ann Osei-Twum
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Adam Rapoport
- Pediatric Advanced Care Team, The Hospital for Sick Children, Toronto, Ontario, Canada
- Emily's House, Toronto, Ontario, Canada
- Department of Pediatrics and University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Christina Vadeboncoeur
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Roger Neilson House, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Kevin Weingarten
- Pediatric Advanced Care Team, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics and University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Veldhuijzen van Zanten
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Roger Neilson House, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Kimberley Widger
- Pediatric Advanced Care Team, The Hospital for Sick Children, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Stinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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12
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Ismail-Pratt I, Mayeaux EJJ, Ngo QV, Lee J, Ng J. A sustainable model for raising colposcopy expertise in low-to-middle-income countries. Int J Gynecol Cancer 2020; 30:1124-1128. [PMID: 32709697 DOI: 10.1136/ijgc-2020-001306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/31/2020] [Accepted: 06/09/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The objective of the study was to assess the effectiveness of training low-to-middle-income countries' local healthcare providers using the Train-the-trainers model in basic colposcopy for cervical cancer prevention. METHOD This project was designed based on a philosophy known as Train-the-trainers which train proficient colposcopists and a cadre of local trainers who can continue to train and maintain their expertise in a self-sustaining system. The Train-the-trainers workshop is a 1-day program that focuses on three domains; knowledge, communication, and practical skills. Trainer candidates were given pre-course reading assignments and presentation decks. The expert trainers provided feedback on their presentations and tips on communication skills. The practical aspects of the training are supported by proficiency at the Loop Electro-excision procedure simulator and their responses to frequently asked questions. RESULTS Sixteen physicians from Vietnam attended the Colposcopy Workshop in 2018 and are used as controls. Eleven attended a workshop conducted by trainer candidates who went through the training program outlined above in 2019. A Wilcoxon Signed-ranks test indicated that differences between pre- and post-quizzes' scores were statistically significant in both the 2018 (Z=4.21, P=0.003, r=1.26) and 2019 cohorts (Z=3.558, P<0.001, r=0.89) while Mann-Whitney U test did not detect the difference between the 2018 and 2019 cohorts, U=70.0, P=0.359, r=0.176. The subjective feedback scores from Year 2019 were similar to scores to Year 2018. CONCLUSION Our preliminary data did not highlight any differences between lectures delivered by expert trainers and lectures delivered by trainer candidates trained in the program. Train-the- trainers might be a more sustainable model for organically raising expertise to effectively provide cervical cancer screening and prevention in low-to-middle-income countries.
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Affiliation(s)
- Ida Ismail-Pratt
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, National University of Singapore, Singapore
| | - Edward John Jr Mayeaux
- Department of Family Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Quang Van Ngo
- Da Nang Center for Disease Control, Vietnam, Da Nang, Vietnam
| | - Jieying Lee
- Keio-NUS CUTE Center, Smart Systems Insitute, National University of Singapore, Singapore
| | - Joseph Ng
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, National University of Singapore, Singapore
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13
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Taylor J, Booth A, Beresford B, Phillips B, Wright K, Fraser L. Specialist paediatric palliative care for children and young people with cancer: A mixed-methods systematic review. Palliat Med 2020; 34:731-775. [PMID: 32362212 PMCID: PMC7243084 DOI: 10.1177/0269216320908490] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Specialist paediatric palliative care services are promoted as an important component of palliative care provision, but there is uncertainty about their role for children with cancer. AIM To examine the impact of specialist paediatric palliative care for children and young people with cancer and explore factors affecting access. DESIGN A mixed-methods systematic review and narrative synthesis (PROSPERO Registration No. CRD42017064874). DATA SOURCES Database (CINAHL, Cochrane Database of Systematic Reviews, Embase, MEDLINE, PsycINFO) searches (2000-2019) identified primary studies of any design exploring the impact of and/or factors affecting access to specialist paediatric palliative care. Study quality was assessed using The Mixed Methods Appraisal Tool. RESULTS An evidence base of mainly low- and moderate-quality studies (n = 42) shows that accessing specialist paediatric palliative care is associated with less intensive care at the end of life, more advance care planning and fewer in-hospital deaths. Current evidence cannot tell us whether these services improve children's symptom burden or quality of life. Nine studies reporting provider or family views identified uncertainties about what specialist paediatric palliative care offers, concerns about involving a new team, association of palliative care with end of life and indecision about when to introduce palliative care as important barriers to access. There was evidence that children with haematological malignancies are less likely to access these services. CONCLUSION Current evidence suggests that children and young people with cancer receiving specialist palliative care are cared for differently. However, little is understood about children's views, and research is needed to determine whether specialist input improves quality of life.
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Affiliation(s)
- Johanna Taylor
- Department of Health Sciences, University of York, York, UK
- Martin House Research Centre, University of York, York, UK
| | - Alison Booth
- Department of Health Sciences, University of York, York, UK
- Martin House Research Centre, University of York, York, UK
| | - Bryony Beresford
- Martin House Research Centre, University of York, York, UK
- Social Policy Research Unit, University of York, York, UK
| | - Bob Phillips
- Martin House Research Centre, University of York, York, UK
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Kath Wright
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Lorna Fraser
- Department of Health Sciences, University of York, York, UK
- Martin House Research Centre, University of York, York, UK
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14
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Friedrichsdorf SJ, Remke S, Hauser J, Foster L, Postier A, Kolste A, Wolfe J. Development of a Pediatric Palliative Care Curriculum and Dissemination Model: Education in Palliative and End-of-Life Care (EPEC) Pediatrics. J Pain Symptom Manage 2019; 58:707-720.e3. [PMID: 31220594 PMCID: PMC6754756 DOI: 10.1016/j.jpainsymman.2019.06.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/08/2019] [Accepted: 06/10/2019] [Indexed: 11/15/2022]
Abstract
CONTEXT Most children living and dying with serious illnesses experience high burden of distressing symptoms. Many seriously ill children and their families do not have access to subspecialist pediatric palliative care (PPC) services nor to clinicians trained in primary PPC. Lack of PPC education appears to be a significant barrier to PPC implementation. OBJECTIVES Description of the development and dissemination of Education in Palliative and End-of-Life Care (EPEC)-Pediatrics. METHODS Funded through a U.S. $1.6 million National Institutes of Health/National Cancer Institute grant 2010-2017, this 24-module curriculum was designed to teach primary palliative care. The target audience included interprofessional pediatric hematology/oncology providers and all other clinicians caring for seriously ill children. RESULTS The curriculum is delivered in a combination of online learning and in-person, face-to-face sessions. In addition, a one-day Professional Development Workshop was developed to teach EPEC-Pediatrics graduates, future "Trainers," thus becoming "Master Facilitators." Between 2012-May 2019, a total of 867 EPEC-Pediatric Trainers and 75 Master Facilitators from 58 countries participated in 17 Become an EPEC-Pediatrics-Trainer conferences and three Professional Development Workshops. The curriculum has also been adapted for large-scale dissemination across Canada and Latin-America, with translation to French and Spanish. Participants overwhelmingly report improvements in their PPC knowledge, attitudes, and skills, including teaching. Trainers subsequently anticipated improvements in patient care for children with serious illness at their home institutions. CONCLUSION EPEC-Pediatrics has developed into the most comprehensive PPC curriculum worldwide. It is highly adaptable for local settings, became self-sustaining and six conferences are offered around the world in 2019.
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Affiliation(s)
- Stefan J Friedrichsdorf
- Department of Pain Medicine, Palliative Care and Integrative Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, USA; Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA.
| | - Stacy Remke
- Department of Pain Medicine, Palliative Care and Integrative Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, USA; University of Minnesota School of Social Work, St. Paul, Minnesota, USA
| | - Joshua Hauser
- Department of Medicine (Palliative Medicine), Northwestern Feinberg School of Medicine, Chicago, Illinois, USA; Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Laurie Foster
- University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Andrea Postier
- Department of Pain Medicine, Palliative Care and Integrative Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, USA
| | - Alison Kolste
- Department of Pain Medicine, Palliative Care and Integrative Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, USA
| | - Joanne Wolfe
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Boston Children's Hospital, Boston, Massachusetts, USA
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15
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Paladino J, Kilpatrick L, O'Connor N, Prabhakar R, Kennedy A, Neal BJ, Kavanagh J, Sanders J, Block S, Fromme E. Training Clinicians in Serious Illness Communication Using a Structured Guide: Evaluation of a Training Program in Three Health Systems. J Palliat Med 2019; 23:337-345. [PMID: 31503520 DOI: 10.1089/jpm.2019.0334] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Failure to initiate discussions about patients' values and goals in serious illness remains a common problem. Many clinicians are inadequately trained for these discussions. Objective: Evaluate whether a novel train-the-trainer model results in high-quality training that improves clinicians' self-reported competencies in serious illness communication. Design: Multimethod evaluation of an educational program. Setting/Context: In 2016, three faculty at Ariadne Labs (AL) conducted three train-the-trainer courses to equip faculty trainers at each of the three institutions to teach serious illness communication to clinicians. Measures: As collected by a post-training questionnaire, primary evaluation measure is clinicians' self-reported change in skills after the training compared with before. Secondary measures include a course evaluation and qualitative learnings. Results: From 2016 to 2018, AL trained 22 trainers (19/22 were palliative care specialists) in three systems, who trained 297 clinicians (49% physicians; 35% advanced practice clinicians; 12% registered nurses, social workers, or chaplain; 4.0% Other) spanning subspecialties (48%); primary care (28%); palliative care (17%); and other (7.1%). Clinicians reported statistically significant improvement in all skills for two of the systems, with a third system demonstrating improvement in all skills with two reaching statistical significance (p < 0.0001). Participants rated the quality of the training highly (95% mostly/extremely effective) and shared a diverse array of takeaways that reflect positive shifts in knowledge, attitudes, and skills. Conclusion: Serious illness communication training, delivered through a train-the-trainer model, was highly acceptable and resulted in significant self-reported improvements in competencies of clinicians. This may be a viable method for health systems seeking to train their clinical workforce.
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Affiliation(s)
- Joanna Paladino
- Ariadne Labs, Brigham and Women's Hospital, Harvard TH Chan School of Public Health, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Laurel Kilpatrick
- Baylor Scott & White Health, Texas A&M University College of Medicine, Bryan, Texas
| | - Nina O'Connor
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Anna Kennedy
- Ariadne Labs, Brigham and Women's Hospital, Harvard TH Chan School of Public Health, Boston, Massachusetts
| | - Brandon J Neal
- Ariadne Labs, Brigham and Women's Hospital, Harvard TH Chan School of Public Health, Boston, Massachusetts
| | - Jane Kavanagh
- Ariadne Labs, Brigham and Women's Hospital, Harvard TH Chan School of Public Health, Boston, Massachusetts
| | - Justin Sanders
- Ariadne Labs, Brigham and Women's Hospital, Harvard TH Chan School of Public Health, Boston, Massachusetts.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Susan Block
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Erik Fromme
- Ariadne Labs, Brigham and Women's Hospital, Harvard TH Chan School of Public Health, Boston, Massachusetts.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
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16
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Widger K, Brennenstuhl S, Duc J, Tourangeau A, Rapoport A. Factor structure of the Quality of Children's Palliative Care Instrument (QCPCI) when complete by parents of children with cancer. BMC Palliat Care 2019; 18:23. [PMID: 30823877 PMCID: PMC6397460 DOI: 10.1186/s12904-019-0406-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 02/19/2019] [Indexed: 12/03/2022] Open
Abstract
Background Currently available indicators of quality pediatric palliative care tend to focus on care provided during the end-of-life period rather than care provided throughout the disease trajectory. We adapted a previously developed instrument focused on mothers’ perspectives on the quality of end-of-life care and assessed its psychometric properties with mothers and fathers of children with cancer at any stage of the illness. Methods Four subscales were included in the analysis: Connect with Families, Involve Parents, Share Information Among Health Professionals, Support Siblings. The number of items across the four subscales was reduced from 31 to 15. We conducted confirmatory factor analysis, composite reliability, internal consistency, and tests of correlation between the overall scale and subscale totals and a separate question inquiring about overall quality of care. Measurement invariance between mothers and fathers was assessed. Results A total of 533 mothers and fathers completed the survey. The four-factor model was confirmed and there were significant correlations between each subscale score and responses to the overall item on care quality. Cronbach’s alpha was adequate for the scale as a whole and for each subscale ranging from 0.78 to 0.90. We also found the factor structure, means, and intercepts were similar across mothers and fathers, suggesting the tool can be used by both groups. Conclusions There is evidence for a four-factor structure within a new Quality of Children’s Palliative Care Instrument (QCPCI) with demonstrated reliability when used with mothers and fathers of children with cancer. Ongoing assessment of the psychometric properties is needed, including testing in additional populations. However, our initial findings suggest that the QCPCI may be a helpful tool for assessing the quality of palliative care for pediatric patients anywhere along the disease trajectory from the perspective of parents.
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Affiliation(s)
- Kimberley Widger
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 130-155 College Street, Toronto, ON, M5T 1P8, Canada. .,Paediatric Advanced Care Team, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
| | - Sarah Brennenstuhl
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 130-155 College Street, Toronto, ON, M5T 1P8, Canada
| | - Jacqueline Duc
- Paediatric Palliative Care Service, Lady Cilento Children's Hospital, Stanley Street, South Brisbane, QLD, 4101, Australia
| | - Ann Tourangeau
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 130-155 College Street, Toronto, ON, M5T 1P8, Canada
| | - Adam Rapoport
- Paediatric Advanced Care Team, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.,Emily's House Children's Hospice, 45 Jack Layton Way, Toronto, ON, M4M 0B7, Canada
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