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Harrison MB, Morrissey DL, Dalrymple WA, D'Abreu A, Daly FN. Primary Palliative Care in Huntington's Disease. Mov Disord Clin Pract 2022; 10:55-63. [PMID: 36698999 PMCID: PMC9847290 DOI: 10.1002/mdc3.13589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 09/12/2022] [Accepted: 09/23/2022] [Indexed: 01/28/2023] Open
Abstract
Background Palliative care practices, including communication about patient-centered goals of care and advance care planning (ACP), have the potential to enhance care throughout the course of Huntington's disease (HD) and related disorders. The goal of our project was to develop a pilot program that integrates primary palliative care practices with interdisciplinary care for HD. Objectives (1) To train HD team members to facilitate goals of care and ACP conversations at all stages of HD; (2) To create materials for care planning in HD focused on patient-centered goals of care and health-related quality of life; and (3) To modify clinic workflow to include goals of care and ACP discussions. Methods We defined planning domains to expand care planning beyond end-of-life concerns. We created a patient and family guide to advance care planning in HD. We conducted VitalTalk communications training with the HD team. We modified the interdisciplinary clinic workflow to include ACP and developed an EMR template for documentation. Results After communication training, more team members felt well prepared to discuss serious news (12.5% to 50%) and manage difficult conversations (25% to 62.5%). The proportion of clinic visits including advance care planning discussions increased from 12.5% to 30.6% during the pilot phase. Conclusions Provision of primary palliative care for HD in an interdisciplinary clinic is feasible. Integration of palliative care practices into HD specialty care requires additional training and modification of clinic operations.
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Affiliation(s)
| | - Dana L. Morrissey
- Department of NeurologyUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - W. Alex Dalrymple
- Department of NeurologyUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - Anelyssa D'Abreu
- Department of NeurologyUniversity of VirginiaCharlottesvilleVirginiaUSA
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Prater LC, O'Rourke B, Schnell P, Xu W, Li Y, Gustin J, Lockwood B, Lustberg M, White S, Happ MB, Retchin SM, Wickizer TM, Bose-Brill S. Examining the Association of Billed Advance Care Planning With End-of-Life Hospital Admissions Among Advanced Cancer Patients in Hospice. Am J Hosp Palliat Care 2021; 39:504-510. [PMID: 34427154 DOI: 10.1177/10499091211039449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Advance care planning (ACP), or the consideration and communication of care preferences for the end-of-life (EOL), is a critical process for improving quality of care for patients with advanced cancer. The incorporation of billed service codes for ACP allows for new inquiries on the association between systematic ACP and improved EOL outcomes. OBJECTIVE Using the IBM MarketScan® Database, we conducted a retrospective medical claims analysis for patients with an advanced cancer diagnosis and referral to hospice between January 2016 and December 2017. We evaluated the association between billed ACP services and EOL hospital admissions in the final 30 days of life. DESIGN This is a cross-sectional retrospective cohort study. PARTICIPANTS A total of 3,705 patients met the study criteria. MAIN MEASURES ACP was measured via the presence of a billed ACP encounter (codes 99497 and 99498) prior to the last 30 days of life; hospital admissions included a dichotomous indicator for inpatient admission in the final 30 days of life. KEY RESULTS Controlling for key covariates, patients who received billed ACP were less likely to experience inpatient hospital admissions in the final 30 days of life compared to those not receiving billed ACP (OR: 0.34; p < 0.001). CONCLUSION The receipt of a billed ACP encounter is associated with reduced EOL hospital admissions in a population of patients with advanced cancer on hospice care. Strategies for consistent, anticipatory delivery of billable ACP services prior to hospice referral may prevent potentially undesired late-life hospital admissions.
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Affiliation(s)
- Laura C Prater
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA.,Division of General Internal Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Brian O'Rourke
- Division of Health Services Management and Policy, The Ohio State University College of Public Health, Columbus, OH, USA
| | - Patrick Schnell
- Division of Biostatistics, The Ohio State University College of Public Health, Columbus, OH, USA
| | - Wendy Xu
- Division of Health Services Management and Policy, The Ohio State University College of Public Health, Columbus, OH, USA
| | - Yiting Li
- Division of Health Services Management and Policy, The Ohio State University College of Public Health, Columbus, OH, USA
| | - Jillian Gustin
- Division of Palliative Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Bethany Lockwood
- Division of Palliative Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Maryam Lustberg
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus OH, USA.,James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Susan White
- James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Mary Beth Happ
- The Ohio State University College of Nursing, Columbus, OH, USA
| | - Sheldon M Retchin
- Division of General Internal Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA.,Division of Health Services Management and Policy, The Ohio State University College of Public Health, Columbus, OH, USA
| | - Thomas M Wickizer
- Division of Health Services Management and Policy, The Ohio State University College of Public Health, Columbus, OH, USA
| | - Seuli Bose-Brill
- Division of General Internal Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
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3
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Merel SE, Spiker M, Stack SW, Paauw DS. "Tell Me More": Students Can Practice and Self-Evaluate Primary Palliative Care Skills in a Large, Multistate Internal Medicine Clerkship. J Palliat Med 2020; 24:261-266. [PMID: 32407163 DOI: 10.1089/jpm.2020.0032] [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: 11/12/2022] Open
Abstract
Background: Experts recommend integrating palliative care throughout the four-year medical school curriculum, including in required clerkships such as internal medicine (IM). Objective: The aim of this study was to determine whether third-year medical students could gain meaningful experience in primary palliative care during their IM clerkship with observation and feedback from internists and/or IM residents or fellows. Design: We implemented two clinical exercises: (1) perform advance care planning with a patient and (2) participate in the delivery of important news. Students self-reported aspects of their experience in a confidential online survey. Setting/Subjects: Third-year medical students enrolled in a required IM clerkship. Measurements: Students reported the setting in which they completed the exercises, their level of independence, and their level of comfort with advance care planning after completing the exercise. We performed a qualitative analysis of open-ended comments to determine domains, themes, and subthemes and a separate analysis to determine the extent to which the comments suggested learning relevant to the stated learning objectives for each exercise. Results: The majority of students completed both exercises without palliative care specialists present, 76% (196/258) for the advance care planning exercise and 75% (195/259) for important news. Fifty-one percent (132/258) of students completed advance care planning with a significant level of independence, and 70% (182/258) reported being comfortable or very comfortable with advance care planning after completing the exercise. Qualitative analyses of student comments found that the majority of students described learning something related to the stated learning objectives for each exercise and suggested that they gained an appreciation of the complexity of patient-provider interactions around serious illness and palliative care. Conclusion: We found it feasible to integrate clinical exercises in advance care planning and delivering important news into an IM clerkship.
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Affiliation(s)
- Susan E Merel
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Michael Spiker
- Department of Medicine, University of California Los Angeles and West Los Angeles VA Medical Center, Los Angeles, California, USA
| | - Shobha W Stack
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Douglas S Paauw
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA.,Rathmann Family Foundation Endowed Chair in Patient-Centered Clinical Education, University of Washington School of Medicine, Seattle, Washington, USA
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4
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Teixeira MJC, Alvarelhão J, Souza D, Teixeira HJC, Abreu W, Costa N, Machado FAB. Healthcare professionals and volunteers education in palliative care to promote the best practice–an integrative review. Scand J Caring Sci 2019; 33:311-328. [DOI: 10.1111/scs.12651] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 12/12/2018] [Indexed: 01/15/2023]
Affiliation(s)
- Maria João C. Teixeira
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care Cicely Saunders Institute Kings College of London London UK
| | | | - Dayse Souza
- Centro Universitário Adventist – UNASP São Paulo Brazil
- Research Centre ‘Didactic and Technology in the Education of Educators (CIDTFF/UA) Aveiro Portugal
| | | | - Wilson Abreu
- School of Nursing & Research Centre Centre for Health Technology and Services Research/ESEP –CINTESIS Porto Portugal
| | - Nilza Costa
- University of Aveiro – Research Centre ‘Didactic and Technology in the Education of Educators/CIDTFF’ Aveiro Portugal
| | - Flávia A. B. Machado
- University of Aveiro – Research Centre ‘Didactic and Technology in the Education of Educators/CIDTFF’ Aveiro Portugal
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Hayley DC, Kalender-Rich JL, Mack J, Swagerty D. Development of a Hybrid Simulated Patient Experience to Practice Care of the Dying Older Adult. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2018; 14:10777. [PMID: 30800977 PMCID: PMC6342370 DOI: 10.15766/mep_2374-8265.10777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 10/22/2018] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Care of the dying older adult includes critical skills that emerging physicians should master but are not consistently taught. Simulation has been shown to be an excellent tool for teaching these skills in a standardized fashion. Simulation allows direct observation to assess and provide learner feedback. Our goal was to develop a learning activity to practice skills caring for the older adult at the end of life and identify areas in need of improvement. METHODS We developed a hybrid simulation in which fourth-year medical students and internal medicine (IM) residents cared for a 70-year-old patient (Laerdal SimMan 3G) who was actively dying in the emergency department. He was accompanied by his wife (standardized patient) and a nurse (standardized role). Over the academic year 2012-2013, we observed and videotaped 83 fourth-year medical students and 22 first-year IM residents in this setting. We assessed the learners' completion of 15 tasks associated with good end-of-life care. RESULTS All learners demonstrated professional activity working with the nurse, and all medical students but one gave opioids appropriately for pain. Only 19% of the medical students appropriately disclosed the patient's status to the wife using the words death and/or dying, and only 50% of the IM residents did so. DISCUSSION We successfully developed a learning activity in which learners can practice their skills caring for the dying older adult. We also determined that there is opportunity for improvement concerning communication, especially with the use of the words death and dying.
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Affiliation(s)
- Déon Cox Hayley
- Professor, Division of General and Geriatric Medicine, Department of Internal Medicine, University of Kansas School of Medicine
| | - Jessica L. Kalender-Rich
- Associate Professor, Division of General and Geriatric Medicine, Department of Internal Medicine, University of Kansas Medical Center
| | - Julie Mack
- Director, Standardized Patient Program, NEIS Clinical Skills Lab, Office of Medical Education, University of Kansas School of Medicine
| | - Daniel Swagerty
- Professor, Department of Geriatrics, Wright State University Boonshoft School of Medicine
- Chair, Department of Geriatrics, Wright State University Boonshoft School of Medicine
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6
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Bryce C, Kam-Magruder J, Jackson J, Ledford CJW, Unwin BK. Palliative Care Education in the Family Medicine Clerkship: A CERA Study. PRIMER : PEER-REVIEW REPORTS IN MEDICAL EDUCATION RESEARCH 2018; 2:20. [PMID: 32818192 DOI: 10.22454/primer.2018.457651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Introduction Inadequate training of medical students in palliative care has been identified as a barrier to its universal provision. Family medicine physicians frequently provide these services, yet the extent of palliative care training in the family medicine clerkship has been unknown. This study describes the status of palliative care training in the family medicine clerkship, as well as clerkship director perceptions of this training. Methods Data were attained through a cross-sectional survey of 141 US and Canadian family medicine clerkship directors administered in fall 2016. Survey items included clerkship director perceived value, interest, and background in palliative care education; presence of educational objectives; hours of training provided; and perceived barriers to palliative care instruction. Results Of the clerkship directors who responded (120/141, 81.5%), 31 (25.8%) reported providing no palliative care education and 75 (62.5%) reported palliative care competencies were not specifically assessed. Background in palliative care and explicit educational objectives were associated with more hours of training in palliative care. Clerkship director training in palliative care correlated with value of teaching it in the clerkship. Conclusion Palliative care education in the family medicine clerkship is prevalent but a large portion of clerkships do not offer it, and the majority of clerkship directors do not evaluate this learning. Our study found a positive correlation between clerkship director training in palliative care and value placed on palliative training in the family medicine clerkship. Assessing this training in the family medicine clerkship and pursuing additional clerkship director training in the subject could improve the overall quality of education provided.
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Affiliation(s)
- Carl Bryce
- Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Janel Kam-Magruder
- Alaska Family Medicine Residency (Anchorage, AK), Alaska Hospice and Palliative Care Fellowship, and University of Washington School of Medicine, (Seattle, WA)
| | | | - Christy J W Ledford
- Department of Family Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Brian K Unwin
- Geriatrics and Palliative Medicine Section, Virginia Tech Carilion School of Medicine (Roanoke, VA)
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Objective Evaluation of a Didactic Curriculum for the Radiation Oncology Medical Student Clerkship. Int J Radiat Oncol Biol Phys 2018; 101:1039-1045. [PMID: 29908787 DOI: 10.1016/j.ijrobp.2018.04.052] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/06/2018] [Accepted: 04/18/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE A structured didactic radiation oncology clerkship curriculum for medical students is in use at multiple academic medical centers. Objective evidence supporting this educational approach over the traditional clerkship model is lacking. This study evaluated the curriculum efficacy using an objective knowledge assessment. METHODS AND MATERIALS Medical students received the Radiation Oncology Education Collaborative Study Group (ROECSG) curriculum consisting of 3 lectures (Overview of Radiation Oncology, Radiation Biology/Physics, and Practical Aspects of Simulation/Radiation Emergencies) and a radiation oncology treatment-planning workshop. A standardized 20-item multiple choice question (MCQ) knowledge assessment was completed pre- and post-curriculum and approximately 6 months after receiving the curriculum. RESULTS One hundred forty-six students at 22 academic medical centers completed the ROECSG curriculum from July to November 2016. One hundred nine students completed pre- and post-clerkship MCQ knowledge assessments (response rate 74.7%). Twenty-four students reported a prior rotation at a ROECSG institution and were excluded from analysis. Mean assessment scores increased from pre- to post-curriculum (63.9% vs 80.2%, P < .01). Mean MCQ knowledge subdomain assessment scores all improved post-curriculum (t test, P values < .01). Post-scores for students rotating de novo at ROECSG institutions (n = 30) were higher compared with pre-scores for students with ≥1 prior rotations at non-ROECSG institutions (n = 55) (77.3% vs 68.8%, P = .01), with an effect size of 0.8. Students who completed rotations at ROECSG institutions continued to demonstrate a trend toward improved performance on the objective knowledge assessment at approximately 6 months after curriculum exposure (70.5% vs 65.6%, P = .11). CONCLUSIONS Objective evaluation of a structured didactic curriculum for the radiation oncology clerkship at early and late time points demonstrated significant improvement in radiation oncology knowledge. Students who completed clerkships at ROECSG institutions performed objectively better than students who completed clerkships at non-ROECSG institutions. These results support including a structured didactic curriculum as a standard component of the radiation oncology clerkship.
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8
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Storarri ACM, de Castro GD, Castiglioni L, Cury PM. Confidence in palliative care issues by medical students and internal medicine residents. BMJ Support Palliat Care 2017; 9:e1. [PMID: 29248898 DOI: 10.1136/bmjspcare-2017-001341] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 11/14/2017] [Accepted: 11/22/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Palliative care (PC) is a relatively new field in Brazil, but this knowledge is of great importance in medical practice. OBJECTIVE To evaluate the degree of confidence among medical students and first-year and second-year internal medicine residents in addressing issues of death and terminal illness with patients and their families. METHOD A modified version of the Self-Efficacy in Palliative Care Scale was applied to 293 students in their first year to sixth year at the School of Medicine of São José do Rio Preto and to 43 residents in their first year or second year of medical practice at the same institution in Brazil, in 2015. The questionnaire evaluated students' opinions on the need to include theoretical and practical classes on PC in the medical school. RESULTS Students in their fifth year of medical school were more confident than the students in their first, second, third and fourth years; there were no statistically significant differences between fifth-year students, sixth-year students and the internal medicine residents. CONCLUSION Residents were more confident than all of the medical school students except those in their fifth year (P<0.05) because they have more contact with terminally ill patients than other students do; fifth-year medical students are likely overestimating their abilities.
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Affiliation(s)
| | | | - Lilian Castiglioni
- Department of Bioestatistic, Faculdade de Medicina de São José do Rio Preto, Brazil, South America
| | - Patricia Maluf Cury
- FACERES Medical School, Faculdade de medicina de São José do Rio Preto, Brazil, South America
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9
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Oskvarek JJ, Brower JV, Mohindra P, Raleigh DR, Chmura SJ, Golden DW. Educational Impact of a Structured Radiation Oncology Clerkship Curriculum: An Interinstitutional Comparison. J Am Coll Radiol 2017; 14:96-102. [PMID: 27652570 PMCID: PMC5222702 DOI: 10.1016/j.jacr.2016.07.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 05/29/2016] [Accepted: 07/19/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE Many medical school clerkships have structured curricula; however, most radiation oncology clerkships do not. The Radiation Oncology Education Collaborative Study Group (ROECSG) implemented a curriculum for fourth-year radiation oncology clerkships at 14 institutions. We hypothesized that students completing clerkships with the curriculum would report greater subjective knowledge and comfort to function as a radiation oncology resident compared with students completing clerkships without the curriculum. METHODS The ROECSG curriculum included three 1-hour lectures and a 1-hour hands-on radiation treatment planning workshop. Applicants to a single radiation oncology residency program in the 2014-2015 academic year were sent an anonymous, validated clerkship experience survey. Students indicated if clerkships were completed at a curriculum site. Likert-type data (1 = not at all, 5 = extremely) are reported as median (interquartile range). RESULTS Respondents described 276 clerkship experiences, of which 64 (23.2%) were completed at a curriculum site. Students whose first clerkship was at a curriculum site perceived greater postclerkship confidence in knowledge of radiation biology (3 [3-4] versus 2 [2-3], P < .01), treatment setup/positioning (3 [2-3] versus 2 [2-3], P < .05), treatment planning (3 [2-3] versus 2 [2-3], P < .01), and ability to integrate evidence-based medicine into treatment (4 [2-4] versus 3 [2-4], P < .05). Students who completed any clerkship with the curriculum had greater postclerkship confidence to function as a radiation oncology resident (3 [3-4] versus 3 [2-3], P < .05). CONCLUSIONS These results support the curriculum's ability to increase student knowledge in radiation oncology, especially in the students' first clerkship. Further, these findings suggest that expanded implementation of such curricula may ensure a rewarding educational experience during radiation oncology clerkships.
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Affiliation(s)
| | - Jeffrey V Brower
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Pranshu Mohindra
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - David R Raleigh
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, California
| | - Steven J Chmura
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois
| | - Daniel W Golden
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois.
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Fitzpatrick D, Heah R, Patten S, Ward H. Palliative Care in Undergraduate Medical Education—How Far Have We Come? Am J Hosp Palliat Care 2016; 34:762-773. [DOI: 10.1177/1049909116659737] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose: There is an increasing demand for quality palliative care teaching within undergraduate medical education. Studies suggest that many junior doctors feel underprepared to perform end-of-life care. Previous systematic reviews on palliative care teaching within medical schools have identified significant variability and lack of consistency in teaching. This review aims to update the literature on the current status of palliative care teaching to undergraduates within medical schools. Method: A systematic review was undertaken on articles published from December 2001 to November 2015 on palliative care teaching for undergraduate medical students. In all, 650 abstract citations were obtained, of which 126 were relevant to the research questions. Thematic analysis was performed on remaining articles according to whether they discussed content and/or methodology of palliative care education, and data collated. Results: There is greater consistency in the content being delivered as part of end-of-life care education within medical schools. The most frequently taught topics include attitudes to death and dying, communication skills, and pain management. Pediatric care and religious/cultural issues are less frequently addressed. Teaching institutions are also utilising a broader range of teaching modalities. Conclusion: There is significant progress in palliative care education within medical schools. Ongoing challenges relate to correlating our current practice in medical education to professional recommendations and the expressed needs of junior doctors to practice competent end-of-life care.
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Affiliation(s)
- Danielle Fitzpatrick
- Adelaide Health Simulation and Skills Centre, The University of Adelaide, Adelaide, Australia
| | - Rebecca Heah
- Adelaide Health Simulation and Skills Centre, The University of Adelaide, Adelaide, Australia
| | - Simon Patten
- Adelaide Health Simulation and Skills Centre, The University of Adelaide, Adelaide, Australia
| | - Helena Ward
- Medicine Learning and Teaching Unit, The University of Adelaide, Adelaide, Australia
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11
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Singh AL, Klick JC, McCracken CE, Hebbar KB. Evaluating Hospice and Palliative Medicine Education in Pediatric Training Programs. Am J Hosp Palliat Care 2016; 34:603-610. [PMID: 27122617 DOI: 10.1177/1049909116643747] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Hospice and Palliative Medicine (HPM) competencies are of growing importance in training general pediatricians and pediatric sub-specialists. The Accreditation Council for Graduate Medical Education (ACGME) emphasized pediatric trainees should understand the "impact of chronic disease, terminal conditions and death on patients and their families." Currently, very little is known regarding pediatric trainee education in HPM. METHODS We surveyed all 486 ACGME-accredited pediatric training program directors (PDs) - 200 in general pediatrics (GP), 57 in cardiology (CARD), 64 in critical care medicine (CCM), 69 in hematology-oncology (ONC) and 96 in neonatology (NICU). We collected training program's demographics, PD's attitudes and educational practices regarding HPM. RESULTS The complete response rate was 30% (148/486). Overall, 45% offer formal HPM curriculum and 39% offer a rotation in HPM for trainees. HPM teaching modalities commonly reported included conferences, consultations and bedside teaching. Eighty-one percent of all respondents felt that HPM curriculum would improve trainees' ability to care for patients. While most groups felt that a HPM rotation would enhance trainees' education [GP (96%), CARD (77%), CCM (82%) and ONC (95%)], NICU PDs were more divided (55%; p < 0.05 for all comparisons vs. NICU). CONCLUSION While most programs report perceived benefit from HPM training, there remains a paucity of opportunities for pediatric trainees. Passive teaching methods are frequently utilized in HPM curricula with minimal diversity in methods utilized to teach HPM. Opportunities to further emphasize HPM in general pediatric and pediatric sub-specialty training remains.
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Affiliation(s)
- Arun L Singh
- 1 Division of Pediatric Critical Care, Emory University School of Medicine, Atlanta, GA, USA.,2 Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,3 Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA
| | - Jeffrey C Klick
- 3 Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA
| | - Courtney E McCracken
- 2 Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Kiran B Hebbar
- 1 Division of Pediatric Critical Care, Emory University School of Medicine, Atlanta, GA, USA.,2 Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,3 Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA
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Wiener L, Weaver MS, Bell CJ, Sansom-Daly UM. Threading the cloak: palliative care education for care providers of adolescents and young adults with cancer. CLINICAL ONCOLOGY IN ADOLESCENTS AND YOUNG ADULTS 2015; 5:1-18. [PMID: 25750863 PMCID: PMC4350148 DOI: 10.2147/coaya.s49176] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Medical providers are trained to investigate, diagnose, and treat cancer. Their primary goal is to maximize the chances of curing the patient, with less training provided on palliative care concepts and the unique developmental needs inherent in this population. Early, systematic integration of palliative care into standard oncology practice represents a valuable, imperative approach to improving the overall cancer experience for adolescents and young adults (AYAs). The importance of competent, confident, and compassionate providers for AYAs warrants the development of effective educational strategies for teaching AYA palliative care. Just as palliative care should be integrated early in the disease trajectory of AYA patients, palliative care training should be integrated early in professional development of trainees. As the AYA age spectrum represents sequential transitions through developmental stages, trainees experience changes in their learning needs during their progression through sequential phases of training. This article reviews unique epidemiologic, developmental, and psychosocial factors that make the provision of palliative care especially challenging in AYAs. A conceptual framework is provided for AYA palliative care education. Critical instructional strategies including experiential learning, group didactic opportunity, shared learning among care disciplines, bereaved family members as educators, and online learning are reviewed. Educational issues for provider training are addressed from the perspective of the trainer, trainee, and AYA. Goals and objectives for an AYA palliative care cancer rotation are presented. Guidance is also provided on ways to support an AYA's quality of life as end of life nears.
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Affiliation(s)
- Lori Wiener
- Pediatric Oncology Branch, National Cancer Institute, NIH,
Bethesda, MD, USA
| | - Meaghann Shaw Weaver
- Department of Oncology, Children's National Health System,
Washington, DC, USA
- Department of Oncology, St Jude Children's Research
Hospital, Memphis, TN, USA
| | - Cynthia J Bell
- College of Nursing, Wayne State University and Hospice of
Michigan Institute, Detroit, MI, USA
| | - Ursula M Sansom-Daly
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney
Children's Hospital, Randwick, NSW, Australia
- Discipline of Paediatrics, School of Women's and Children's
Health, UNSW Medicine, The University of New South Wales, Kensington, NSW,
Australia
- Sydney Youth Cancer Service, Sydney Children's/Prince of
Wales Hospitals, Randwick, NSW, Australia
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