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Engel KG, Millham LRI, Yeh IM, Malecha PW, Brizzi K, Schwartz AW, Tolchin DW. Assessing the Impact of a Hospice and Palliative Medicine Mentored Clinical Shadowing Experience for First-Year Medical and Dental Students: A Pilot Study. Am J Hosp Palliat Care 2024; 41:1018-1028. [PMID: 37950642 DOI: 10.1177/10499091231214787] [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: 11/13/2023] Open
Abstract
Background: All physicians encounter patients with serious illness. Medical students recognize the value of hospice and palliative medicine (HPM) and desire more knowledge and skills in this area. However, both pre-clinical and clinical HPM content are underrepresented within medical school curricula. Objectives: To conduct a pilot study examining the impact of a novel required HPM clinical experience on pre-clinical medical and dental students' learning through mixed methods evaluation of student responses. Design: Students completed a two-part electronic survey following a half-day HPM mentored clinical shadowing experience (HPM-MCSE) which included an introductory session, a faculty-mentored shadowing experience and a debriefing session. Setting/subjects: 163 first-year students at Harvard Medical School in Boston, Massachusetts, USA in 2022. Measurements: The survey collected demographic information and student responses to both closed-ended (Likert-scale) and open-ended prompts. Data were analyzed quantitatively using descriptive statistics and qualitatively using constant comparative methodology. Results: 127 medical and dental students responded (78% response rate). Qualitative analysis yielded three overarching themes: acquisition of knowledge about operational dimensions of HPM, acquisition of knowledge about psychosocial dimensions of HPM, and personal impact including an awareness of discordance between expectations and lived experience of HPM practice. Of the 109 students who completed the entire survey, 67% indicated that this experience increased their interest in palliative care and 98% reported an increase in their understanding of how palliative care enhances patient care. Conclusions: Early clinical exposure to HPM for first year students stimulates multi-dimensional learning about HPM and evokes personal reflection about serious illness care.
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Affiliation(s)
- Kirsten G Engel
- Harvard Medical School, Boston, MA, USA
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Lucia R I Millham
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Irene M Yeh
- Harvard Medical School, Boston, MA, USA
- Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Patrick W Malecha
- Harvard Medical School, Boston, MA, USA
- Section of Palliative Care, Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kate Brizzi
- Harvard Medical School, Boston, MA, USA
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Andrea Wershof Schwartz
- Harvard Medical School, Boston, MA, USA
- New England Geriatrics Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA
- Division of Aging, Brigham and Women's Hospital, Boston, MA, USA
| | - Dorothy W Tolchin
- Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA, USA
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Lopez V, van der Keylen P, Kühlein T, Sebastião M. Psychological stress of general practitioners in the care of patients with palliative care needs: an exploratory study. BMC Palliat Care 2024; 23:197. [PMID: 39097720 PMCID: PMC11297742 DOI: 10.1186/s12904-024-01529-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 07/23/2024] [Indexed: 08/05/2024] Open
Abstract
BACKGROUND In Germany, general practitioners play a pivotal role in palliative care provision. Caring for patients with palliative care needs can be a burden for general practitioners, highlighting the importance of self-care and mental health support. This study aimed to explore the role of palliative care in general practitioners' daily work, the stressors they experience, their coping mechanisms, and the potential benefits of Advance Care Planning in this context. METHODS An exploratory approach was employed, combining a short quantitative survey with qualitative interviews. The analysis was based on a structuring qualitative content analysis, following a deductive-inductive procedure and integrating the Stress-Strain Model and Lazarus' Transactional Model of Stress and Coping. We recruited eleven general practitioners to take part in the study. RESULTS General practitioners viewed palliative care as integral to their practice but faced challenges such as time constraints and perceived expertise gaps. Societal taboos often hindered conversations on the topic of death. Most general practitioners waited for their patients to initiate the topic. Some general practitioners viewed aspects of palliative care as potentially distressing. They used problem-focused (avoiding negative stressors, structuring their daily schedules) and emotion-focused (discussions with colleagues) coping strategies. Still, general practitioners indicated a desire for specific psychological support options. Advance Care Planning, though relatively unfamiliar, was acknowledged as valuable for end-of-life conversations. CONCLUSIONS Palliative care can be associated with negative psychological stress for general practitioners, often coming from external factors. Despite individual coping strategies in place, it is advisable to explore concepts for professional psychological relief. TRIAL REGISTRATION Not registered.
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Affiliation(s)
- Verena Lopez
- Institute of General Practice, Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Universitätsstr. 29, 91054, Erlangen, Germany
| | - Piet van der Keylen
- Institute of General Practice, Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Universitätsstr. 29, 91054, Erlangen, Germany
- Lutheran University of Applied Sciences, Nürnberg, Germany
| | - Thomas Kühlein
- Institute of General Practice, Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Universitätsstr. 29, 91054, Erlangen, Germany
| | - Maria Sebastião
- Institute of General Practice, Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Universitätsstr. 29, 91054, Erlangen, Germany.
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Lisai-Goldstein Y, Shaulov A. Medical Students' Experience of a Patient's Death and Their Coping Strategies: A Narrative Literature Review. Am J Hosp Palliat Care 2024:10499091241264523. [PMID: 38906091 DOI: 10.1177/10499091241264523] [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: 06/23/2024] Open
Abstract
The experience of a patient's death on medical students is powerful and may entail distress and anxiety. We review the experience of death and dying as perceived by medical students. Students are exposed to death and dying while dissecting cadavers in pre-clinical years, following patient death in clinical years, and commonly as a result of personal exposure. Students report sadness and anger in response to patient death, particularly following their first experience. The patient's identity and the student's past exposure to death were found to influence the way students experience death and dying. Coping methods may include conversation, reflection, and religion as well as detachment and avoidance. Although time and resources are invested in preparing students for a patient's death, many of them feel inadequately prepared. Greater understanding of and investment in processing medical students' experience of patient death may be helpful in their personal and professional development.
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Affiliation(s)
| | - Adir Shaulov
- Department of Hematology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
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Juan DWK, Ng IAT, Wong LCK, Fong WJ, Lee PP, Lie SA, Zhou JX, Cai M, Ong JCA, Seo JCJ, Chia CS, Wong JSM. Knowledge and thresholds for palliative care and surgery among healthcare providers caring for adults with serious illness. Front Med (Lausanne) 2024; 11:1351864. [PMID: 38882666 PMCID: PMC11179431 DOI: 10.3389/fmed.2024.1351864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 05/20/2024] [Indexed: 06/18/2024] Open
Abstract
Introduction Timely palliative care and surgical interventions improve symptoms, health-related quality of life (HRQoL), and reduce medical cost for seriously ill adults at end of life (EOL). However, there is still poor delivery and underutilization of these palliative services. We hypothesize that the sub-optimal delivery is due to limited understanding among healthcare providers. Methods A nationwide cross-sectional online survey was conducted among primary and tertiary healthcare providers. The survey assessed challenges faced, palliative education, confidence in managing palliative patients, and knowledge on palliative surgery. Overall palliative care awareness and knowledge was assessed using a 6-point score. Likelihood of considering various palliative interventions at EOL was also determined using a threshold score (higher score = higher threshold). Results There were 145 healthcare providers who completed the survey (81.9% response rate); majority reported significant challenges in providing various aspects of palliative care: 57% (n = 82) in the provision of emotional support. Sixty-nine percent (n = 97) in managing social issues, and 71% (n = 103) in managing family expectations. Most expressed inadequate palliative care training in both under-graduate and post-graduate training and lack confidence in managing EOL issues. Up to 57% had misconceptions regarding potential benefits, morbidity and mortality after palliative surgery. In general, most providers had high thresholds for Intensive Care Unit admissions and palliative surgery, and were more likely to recommend endoscopic or interventional radiology procedures at EOL. Conclusion Healthcare providers in Singapore have poor knowledge and misconceptions about palliative care and surgery. Improving awareness and education among those caring for seriously ill adults is essential.
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Affiliation(s)
- Darryl Wen Kai Juan
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
| | - Irene Ai Ting Ng
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
| | - Louis Choon Kit Wong
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
| | - Wei Jing Fong
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
| | - Piea Peng Lee
- Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Sui An Lie
- Division of Anaesthesiology, Singapore General Hospital, Singapore, Singapore
| | - Jamie Xuelian Zhou
- Division of Supportive and Palliative Care, National Cancer Centre, Singapore, Singapore
| | - Mingzhe Cai
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
| | - Johnny Chin-Ann Ong
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
- SingHealth Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- SingHealth Duke-NUS Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore
- Institute of Molecular and Cell Biology, A*STAR Research Entities, Singapore, Singapore
| | - Jane Chin Jin Seo
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
| | - Claramae Shulyn Chia
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
- SingHealth Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Jolene Si Min Wong
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
- SingHealth Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
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Reidy JA, Brizzi K, Chan SH, Day H, Epstein SK, Fischer M, Garg PS, Gosline A, Jaramillo C, Livne E, Mitchell S, Morgan S, Olmsted MW, Stebbins P, Stumpf I, Vesel T, Yeh IM, Young ME, Goldman RE. Curricular Reform in Serious Illness Communication and Palliative Care: Using Medical Students' Voices to Guide Change. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:550-557. [PMID: 38277443 DOI: 10.1097/acm.0000000000005647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
PURPOSE To gather and leverage the voices of students to drive creation of required, integrated palliative care curricula within undergraduate medical education in Massachusetts, which is lacking in a majority of U.S. medical schools. METHOD The study was conducted by the Massachusetts Medical Schools' Collaborative, a working group committed to ensuring all medical students in Massachusetts receive foundational training in serious illness communication (SIC) and palliative care. Eight focus groups (2 per participating medical school) were conducted during January-May 2021 and included a total of 50 students from Boston University Chobanian & Avedisian School of Medicine, Harvard Medical School, Tufts University School of Medicine, and the UMass Chan Medical School. Data collected from focus groups were discussed and coded. Themes were identified using the immersion/crystallization qualitative data analysis approach. RESULTS Six key themes emerged. Students viewed SIC as essential to high-quality medical practice regardless of specialty, and believed training in SIC skills and palliative care should be required in medical school curricula. Students preferred to learn and practice these skills using frameworks, particularly in real-world situations. Students recognized the expertise of palliative care specialists and described them as a scarce, often misunderstood resource in health care. Students reported it was mostly "luck" if they were included in family meetings and observed good role models. Finally, students desired practice in debriefing after difficult and emotional situations. CONCLUSIONS This study confirms long-standing themes on students' experiences with SIC and palliative care topics, including feeling inadequately prepared to care for seriously ill patients as future physicians. Our study collected students' perspectives as actionable data to develop recommendations for curricular change. Collaborative faculty also created recommendations based on the focus group data for immediate and ongoing SIC and palliative care curricular change in Massachusetts, which can apply to medical schools nationwide.
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Chua KLM, Chan JQV, Tan LLC, Low JA. Facts to Snacks. Evaluating the Effectiveness of Bite-Sized Animations in Teaching Palliative Care to Medical Students. Am J Hosp Palliat Care 2024:10499091241240053. [PMID: 38520168 DOI: 10.1177/10499091241240053] [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: 03/25/2024] Open
Abstract
BACKGROUND Current palliative care training in medical school is inadequate in preparing doctors to provide quality palliative care. Little attention is paid to determining effective methods of training. OBJECTIVE To assess the use of bite-sized animations in improving the confidence, knowledge and attitudes of medical students towards palliative care. METHODS A mixed methods cohort study was adopted for the study. 50 medical students without prior palliative training completed questionnaires before and after watching a 12-part animated palliative care video series called PowerFacts. Of these participants, 18 underwent semi-structured interviews. RESULTS The quantitative results showed that animations are effective in improving the confidence (P < .001) and knowledge (P < .001), but not the attitudes (P = .183) of medical students. Confidence, knowledge and attitudes were not correlated. Analysis of follow-up interviews of a convenience sample of participants showed that animations can be effective in teaching knowledge and does fill some gaps in palliative education for medical undergraduates. However, the content delivered as a sole learning tool is inadequate in preparing medical students for clinical practice. CONCLUSION All participants achieved level 1 (reaction), some achieved level 2 (learning) but most did not achieve level 3 (behaviour) of the Kirkpatrick's model. There is a need for a multimodal approach in the comprehensive teaching of palliative care in undergraduate medical training to achieve all four levels of the Kirkpatrick Model.
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Affiliation(s)
- Kai Lin Megan Chua
- Lee Kong Chian School Of Medicine, Nanyang Technological University, Singapore
| | - Jin Qi Valerie Chan
- Lee Kong Chian School Of Medicine, Nanyang Technological University, Singapore
| | - Laurence Lean Chin Tan
- GeriCare, Khoo Teck Puat Hospital, Singapore
- Department of Geriatric Medicine and Palliative Care, Khoo Teck Puat Hospital, Singapore
- Department of Knowledge Translation, Geriatric Education and Research Institute (GERI), Singapore
| | - James Alvin Low
- GeriCare, Khoo Teck Puat Hospital, Singapore
- Department of Geriatric Medicine and Palliative Care, Khoo Teck Puat Hospital, Singapore
- Department of Knowledge Translation, Geriatric Education and Research Institute (GERI), Singapore
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7
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Sagin A, Balmer D, Rose S, Musheno R, Olenik JM, Dingfield L, Dine CJ, Bennett NL. Evaluation of a Palliative Care Longitudinal Curriculum for Medical Students Using the Context-Input-Process-Product Model. Am J Hosp Palliat Care 2024; 41:158-166. [PMID: 36945136 PMCID: PMC10751966 DOI: 10.1177/10499091231165504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
Palliative care (PC) longitudinal curricula are increasingly being recognized as important in Undergraduate Medical Education (UME). They are however, not yet commonplace, and where they do exist may be implemented without a systematic, prospective approach to curriculum evaluation. This paper describes an implementation of a new longitudinal curriculum at the Perelman School of Medicine (PSOM) at the University of Pennsylvania. We used the Context Input Process Product (CIPP) model, a holistic evaluation model, to assess the local environment, design the curriculum, guide the improvement process, and evaluate outcomes. Comprehensive models such as CIPP provide a more robust approach to curriculum evaluation than outcomes-only models and may be of use to other programs who are implementing new curricula or improving upon existing programs.
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Affiliation(s)
- Alana Sagin
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Dorene Balmer
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Suzanne Rose
- Medicine/Academic Programs, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Rosie Musheno
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jennifer M. Olenik
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Laura Dingfield
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - C. Jessica Dine
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Nadia L. Bennett
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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8
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Murphy R, Barnes CJ, Enright PD, Gratton V, Bush SH. Mapping an undergraduate medical education curriculum against national and international palliative care reference learning objectives. BMC MEDICAL EDUCATION 2024; 24:105. [PMID: 38303063 PMCID: PMC10836050 DOI: 10.1186/s12909-024-05082-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/22/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND The teaching of palliative care competencies is an essential component of undergraduate medical education. There is significant variance in the palliative care content delivered in undergraduate medical curricula, revealing the utility of reference standards to guide curricular development and assessment. To evaluate our university's undergraduate palliative care teaching, we undertook a curriculum mapping exercise, comparing official learning objectives to the national Educating Future Physicians in Palliative and End-of-Life Care (EFPPEC) and the international Palliative Education Assessment Tool (PEAT) reference objectives. METHODS Multiple assessors independently compared our university's UGME learning objectives with EFPPEC and PEAT reference objectives to determine the degree-of-coverage. Visual curriculum maps were created to depict in which part of the curriculum each objective is delivered and by which medical specialty. RESULTS Of 122 EFPPEC objectives, 55 (45.1%) were covered fully, 42 (34.4%) were covered partially, and 25 (20.5%) were not covered by university objectives. Of 89 PEAT objectives, 40 (44.9%) were covered fully, 35 (39.3%) were covered partially, and 14 (15.7%) were not covered by university objectives. CONCLUSIONS The majority of EFPPEC and PEAT reference objectives are fully or partially covered in our university's undergraduate medical curriculum. Our approach could serve as a guide for others who endeavour to review their universities' specialty-specific medical education against reference objectives. Future curriculum development should target the elimination of identified gaps and evaluate the attainment of palliative care competencies by medical learners.
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Affiliation(s)
- Rebekah Murphy
- Department of Medicine, Division of Palliative Care, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada.
- Department of Palliative Care, Bruyère Continuing Care, Saint-Vincent Hospital, 60 Cambridge St N, Ottawa, ON, K1R 7A5, Canada.
- Department of Medicine, Queensway Carleton Hospital, 3045 Baseline Rd, Ottawa, ON, K2H 8P4, Canada.
| | - Christopher J Barnes
- Department of Medicine, Division of Palliative Care, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada
- Department of Palliative Care, Bruyère Continuing Care, Saint-Vincent Hospital, 60 Cambridge St N, Ottawa, ON, K1R 7A5, Canada
| | - Paula D Enright
- Department of Medicine, Division of Palliative Care, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada
- Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada
| | - Valerie Gratton
- Department of Medicine, Division of Palliative Care, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada
- Institut du Savoir Montfort, 713 Montréal Rd, Ottawa, ON, K1K 0T2, Canada
- Department of Family Medicine, Montfort Hospital, 713 Montréal Rd, Ottawa, ON, K1K 0T2, Canada
| | - Shirley H Bush
- Department of Medicine, Division of Palliative Care, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada
- Department of Palliative Care, Bruyère Continuing Care, Saint-Vincent Hospital, 60 Cambridge St N, Ottawa, ON, K1R 7A5, Canada
- Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada
- Bruyère Research Institute, 43 Bruyère St, Ottawa, ON, K1N 5C8, Canada
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Reidy JA, Chan SH, Boelitz KM, Chavez M, Clark MA, Epstein SK, Gosline A, Healy R, Livne E, Peirce H, Schaefer KG, Streid J, Vesel T, Young ME, Zehm A, Garg PS. A Call to Action: Using Curriculum Mapping at Four Medical Schools in Massachusetts to Advance Serious Illness Communication Training in Undergraduate Medical Education. J Palliat Med 2024; 27:39-46. [PMID: 37976143 DOI: 10.1089/jpm.2022.0562] [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: 11/19/2023] Open
Abstract
Background: Practicing physicians require serious illness communication (SIC) skills to ensure high-quality, humanistic care for patients and families as they face life-changing medical decisions. However, a majority of U.S. medical schools do not require formal training in SIC and fail to provide students deliberate practice before graduation. The Massachusetts Medical Schools' Collaborative was created to ensure that students receive foundational SIC training in undergraduate medical education. This Collaborative developed a curriculum-mapping tool to assess SIC at four medical schools. Objective: We aimed to understand existing educational activities across four medical schools and identify opportunities to build longitudinal, developmentally based curricular threads in SIC. Design: From July 2019 to April 2021, faculty, staff, and medical students assessed current educational activities related to five core competencies in SIC, adapted for students from national competencies for palliative medicine fellows, using a curriculum mapping tool. Measurements: The group selected 23 keywords and collected metrics to describe the timing, instruction and assessment for each school's educational activities. Results: On average, there were only 40 hours of required curricula in SIC over four years. Over 80% of relevant SIC hours occurred as elective experiences, mostly during the postclerkship phase, with limited capacity in these elective experiences. Only one school had SIC educational activities during the clerkship phase when students are developing clinical competencies. Assessment methods focused on student participation, and no school-assessed clinical performance in the clerkship or postclerkship phase. Conclusions: Medical schools are failing to consistently train and ensure basic competency in effective, compassionate SIC. Curriculum mapping allows schools to evaluate their current state on a particular topic such as SIC, ensure proper assessment, and evaluate curricular changes over time. Through the deliberate inclusion of SIC competencies in longitudinal curriculum design, we can fill this training gap and create best practices in undergraduate medical education.
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Affiliation(s)
- Jennifer A Reidy
- UMass Memorial Medical Health Care, Division of Palliative Care, Worcester, Massachusetts, USA
- UMass Chan Medical School, Departments of Medicine, Pediatrics and Surgery, Worcester, Massachusetts, USA
| | - Stephanie H Chan
- Massachusetts Coalition for Serious Illness Care, Boston, Massachusetts, USA
- Blue Cross Blue Shield of Massachusetts, Boston, Massachusetts, USA
| | - Kris M Boelitz
- UMass Chan Medical School, Departments of Medicine, Pediatrics and Surgery, Worcester, Massachusetts, USA
| | - Melissa Chavez
- Boston Medical Center, Departments of Neurology and Otolaryngology, Boston, Massachusetts, USA
| | - Melissa A Clark
- UMass Chan Medical School, Departments of Medicine, Pediatrics and Surgery, Worcester, Massachusetts, USA
- Brown University School of Public Health, Department of Health Services, Policy and Practice, Providence, Rhode Island, USA
| | - Scott K Epstein
- Tufts University School of Medicine, Department of Medicine, Boston, Massachusetts, USA
| | - Anna Gosline
- Massachusetts Coalition for Serious Illness Care, Boston, Massachusetts, USA
- Blue Cross Blue Shield of Massachusetts, Boston, Massachusetts, USA
| | - Rose Healy
- Boston Medical Center, Departments of Neurology and Otolaryngology, Boston, Massachusetts, USA
| | - Emma Livne
- Hasbro Children's Hospital, Department of Pediatrics, Providence, Rhode Island, USA
| | - Hayden Peirce
- UMass Chan Medical School, Departments of Medicine, Pediatrics and Surgery, Worcester, Massachusetts, USA
| | - Kristen G Schaefer
- Care Dimensions, Inc., Danvers, Massachusetts, USA
- Harvard Medical School, Department of Medicine, Boston, Massachusetts, USA
| | - Jocelyn Streid
- Brigham and Women's Hospital, Department of Anesthesiology, Boston, Massachusetts, USA
| | - Tamara Vesel
- Tufts University School of Medicine, Department of Medicine, Boston, Massachusetts, USA
- Tufts Medical Center, Division of Palliative Care, Boston, Massachusetts, USA
| | - Megan E Young
- Boston University School of Medicine, Departments of Medicine and Pediatrics, Boston, Massachusetts, USA
| | - April Zehm
- Medical College of Wisconsin, Department of Medicine, Milwaukee, Wisconsin, USA
| | - Priya S Garg
- Boston University School of Medicine, Departments of Medicine and Pediatrics, Boston, Massachusetts, USA
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10
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da Cunha Oliveira M, Silva Menezes M, Cunha de Oliveira Y, Marques Vilas Bôas L, Villa Nova Aguiar C, Gomes Silva M. Novice medical students' perception about bad news training with simulation and spikes strategy. PEC INNOVATION 2023; 2:100106. [PMID: 37214516 PMCID: PMC10194387 DOI: 10.1016/j.pecinn.2022.100106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/18/2022] [Accepted: 11/21/2022] [Indexed: 05/24/2023]
Abstract
Objective To analyze the medical students' perception about simulated consultations before and after training using the SPIKES protocol. Methods Quasi-experimental study, with a qualitative approach. It counted with the participation of 20 students as Simulated Physicians (SF), and 20 students as Simulated Patients (SP), all belonging to a medical course. Data were obtained from the responses given to a reflective question, applied before and after training with the SPIKES. The treatment and the analysis of the data were guided by the stages of thematic analysis. Results In the category "Simulated Medical Student's Self-Perception", the subcategories "Nervousness and Insecurity" were predominant after the first consultation, while "Tranquility and Security" after the second consultation after training. In the category "Simulated Medical Student's Perception about the Educational Process", the subcategory "Reflective Learning" emerged in the students' speeches, especially after the second consultation. In the speeches of SP, it was evidenced the improvement of the care provided by SF after training. Conclusion The strategy used for the development of communication skills showed evidence of short-term effectiveness. Innovation The research resulted in a teaching protocol for students in pre-clinical stages that involves four stages: simulation, self-assessment, feedback and new simulations.
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Affiliation(s)
| | | | | | | | | | - Mary Gomes Silva
- Bahiana School of Medicine and Public Health, Salvador, BA, Brazil
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11
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Toussaint V, Paal P, Simader R, Elsner F. The state of undergraduate palliative care education at Austrian medical schools - a mixed methods study. BMC Palliat Care 2023; 22:151. [PMID: 37814283 PMCID: PMC10563205 DOI: 10.1186/s12904-023-01255-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/01/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND There is an increasing demand for universal, high-quality access to palliative care in Austria. To ensure this, the implementation of palliative care in the medical studies curriculum is essential. This is the first study to investigate the state of undergraduate palliative care education at Austrian medical schools. METHODS For this mixed-methods study with concurrent embedded design, expert interviews and online surveys were conducted between March and August 2022. The interviews were subjected to a thematic analysis according to Braun and Clarke, while the questionnaires were analysed descriptively-statistically. For the final integration, the results of both methods for each topic are presented and discussed complementarily. Both the primary qualitative and supportive quantitative data were collected to combine the advantages of the in-depth nature of the qualitative data and the consistent structure of the quantitative data to provide a more precise representation of the state of teaching. RESULTS Twenty-two persons participated in the study, of whom twenty-one participated in the interview and eight in the questionnaire. The participants were experts in palliative care teaching at Austrian medical schools. Currently, palliative care is taught at seven out of the eight universities. Large differences were found in the number of hours, organisation, teaching formats, and interprofessional education. At present, three universities have a chair for palliative care and at least five universities have access to a palliative care unit. CONCLUSION Undergraduate palliative care education in Austria is very heterogeneous and does not meet the minimum standards suggested by the European Association for Palliative Care (EAPC) curriculum recommendations. However, several universities are planning measures to expand palliative care teaching, such as the introduction of mandatory teaching or the establishment of new teaching formats. Better coordination and networking within and between universities would be beneficial for the expansion and quality of teaching.
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Affiliation(s)
- Véronique Toussaint
- Department of Palliative Medicine, Medical Faculty RWTH Aachen University, Aachen, Germany.
| | - Piret Paal
- Institute of Palliative Care, Paracelsus Medical University, Salzburg, Austria
| | - Rainer Simader
- Hospiz Österreich / Österreichische Palliativgesellschaft, Vienna, Österreich
| | - Frank Elsner
- Department of Palliative Medicine, Medical Faculty RWTH Aachen University, Aachen, Germany
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12
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Shaulov A, Finkelstein A, Vashdi I, DeKeyser Ganz F, Kienski Woloski-Wruble A, Rubinstein E, Marcus EL, Lesser L, Shaham D. Interprofessional palliative and end-of-life education: short-term and long-term outcomes - mixed-methods analysis. BMJ Support Palliat Care 2023:spcare-2023-004290. [PMID: 37258087 DOI: 10.1136/spcare-2023-004290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/17/2023] [Indexed: 06/02/2023]
Abstract
ObjectiveInterprofessional care is integral to end-of-life (EOL) and palliative care (PC) and may be suited for EOL and PC education.We evaluate the impact of an interprofessional EOL care curriculum on participants, during the course, on completion and 4 years laterusing quantitative (questionnaires) and qualitative (open-ended questions and interviews) methods.The course included 14 fifth and sixth-year medical students, 9 social work students and 7 nursing students enrolled in master's degree programmes. Seventeen participants completed questionnaires 4 years later and eight participated in interviews.On postcourse questionnaires, participants attributed high value to interprofessional education (IPE) (4.77/5±0.50 on a Likert scale). Four years later, participants reported that IPE impacted their professional (3.65/5±1.11) and personal lives (3.94/5±1.09) and found PC IPE important (4.88/5±0.33).Conventional content analysis showed that the course enabled discussion of death and dying and provided an opportunity for a personal-emotional journey. It offered an approach to EOL care and an opportunity to experience interprofessional teamwork at the EOL resulting in behavioural change.Interprofessional EOL education resulted in meaningful and lasting self-reported personal and professional behavioural outcomes.
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Affiliation(s)
- Adir Shaulov
- Department of Hematology, Hadassah Medical Center and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Adi Finkelstein
- Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel
| | - Inon Vashdi
- School of Medicine, Hadassah and Hebrew University, Jerusalem, Israel
| | - Freda DeKeyser Ganz
- Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel
- Henrietta Szold-Hadassah-Hebrew University School of Nursing in the Faculty of Medicine, Jerusalem, Israel
| | | | | | - Esther-Lee Marcus
- Department of Geriatrics, Herzog Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Lior Lesser
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dorith Shaham
- Department of Radiology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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13
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Zehm A, Smith S, Schaefer KG, Jonas D, Bullock K, Edwards RL, Reville B, Jaramillo C, Webb AC, Rydberg J, Merel SE. Development of Objectives to Inform a National Standardized Primary Palliative Care Curriculum for Health Professions Students. J Palliat Med 2023; 26:406-410. [PMID: 36608317 DOI: 10.1089/jpm.2022.0396] [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: 01/07/2023] Open
Abstract
Introduction: Despite recent educational advances, the need for a national standardized primary palliative care curriculum for health professions students remains evident. Methods: An interprofessional leadership team developed a set of core learning objectives built on previously published competencies. A survey was then sent to palliative care experts for feedback and consensus. Results: Twenty-eight of 31 objectives met a 75% consensus threshold, 2 were combined with others, and 12 were refined based on survey feedback. Discussion: With interprofessional input at all stages, we finalized a comprehensive list of 26 learning objectives for a primary palliative care curriculum targeting health professions students. These objectives will be widely available through an online course but can also be adopted for use by individual educators across health professions institutions. These objectives and related curriculum are critical to producing practice-ready clinicians who are prepared to care for the burgeoning population of seriously ill patients.
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Affiliation(s)
- April Zehm
- Division of Geriatric and Palliative Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sherilyn Smith
- Division of General Internal Medicine, University of Washington School of Medicine, Seattle, Washington, USA.,Aquifer, Inc., Lebanon, New Hampshire, USA
| | - Kristen G Schaefer
- Care Dimensions Hospice, Danvers, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Danielle Jonas
- Silver School of Social Work, New York University, New York, New York, USA
| | - Karen Bullock
- Boston College School of Social Work, Boston College, Chestnut Hill, Massachusetts, USA
| | - Rebecca L Edwards
- UAB School of Nursing, Department of Acute, Chronic, and Continuing Care, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Barbara Reville
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Department of Psychosocial Oncology and Palliative Care, Harvard Medical School Center for Palliative Care, Boston, Massachusetts, USA
| | - Carolina Jaramillo
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Amy Carol Webb
- River of Grass Unitarian Universalist Congregation, Davie, Florida, USA
| | | | - Susan E Merel
- Division of General Internal Medicine, University of Washington School of Medicine, Seattle, Washington, USA.,Cambia Palliative Care Center of Excellence, Seattle, Washington, USA
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14
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Kukimoto Y, Maeda K, Yasui N, Nakamura M. Impact of Palliative and End of Life Care Interprofessional Education for Pre-licensure Healthcare Students: An Integrated Review. Am J Hosp Palliat Care 2023; 40:202-215. [PMID: 35711094 DOI: 10.1177/10499091221108344] [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: 01/19/2023] Open
Abstract
An accelerating aging society and rise in serious illnesses has led to an increase in deaths and made the demand for palliative care even greater. An integrated review was conducted to identify the impact of interprofessional education (IPE) on palliative/end of life (EOL) care for unlicensed health care students with a multidisciplinary approach. The databases searched included MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Education Resources Information Center (ERIC), PsycINFO, and the Cochrane Library's CENTRAL. Fifteen studies were included. Participants' disciplines included medicine, nursing, pharmacy, physical therapy, occupational therapy, social work, chaplain, public health and psychology. Nine were pre-post design and others were post course evaluations. One research study was an interventional trial with a comparative group. The selected studies included a variety of teaching strategies such as simulation or role play, clinical experience, case study, and TOSCE training. The importance of an interprofessional approach to palliative/EOL care has been highlighted, and our review suggests that combined IPE and palliative/EOL interventions can potentially impact palliative/EOL patient outcomes. More studies are needed to clarify the effectiveness of interprofessional palliative/EOL educational interventions including facilitators, learning outcomes, variable methods or teaching strategy, and the level of students.
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Affiliation(s)
- Yukiko Kukimoto
- School of Nursing, 97810Morinomiya University of Medical Sciences, Osaka, Japan
| | - Kaou Maeda
- School of Physical Therapy, 97810Morinomiya University of Medical Sciences, Osaka, Japan
| | - Nagisa Yasui
- School of Nursing, 97810Morinomiya University of Medical Sciences, Osaka, Japan
| | - Megumi Nakamura
- School of Occupational Therapy, 97810Morinomiya University of Medical Sciences, Osaka, Japan
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15
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Reidy JA, Clark MA, Berman HA, Chan SH, Gawande AA, Streid J, Vesel T, Young ME, Zehm A, Schaefer KG. Paving the way for universal medical student training in serious illness communication: the Massachusetts Medical Schools' Collaborative. BMC MEDICAL EDUCATION 2022; 22:654. [PMID: 36050708 PMCID: PMC9438111 DOI: 10.1186/s12909-022-03702-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 08/21/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Patients with serious illness look to their clinicians for discussion and guidance on high-stakes treatment decisions, which are complex, emotional and value-laden. However, required training in serious illness communication is rare in U.S. medical schools, with efforts at curricular reform stymied by competing institutional demands, lack of resources and accreditation requirements. We describe an approach to building and scaling medical student training in serious illness communication through the creation of a statewide collaborative of medical schools. METHODS The Massachusetts Medical Schools' Collaborative is a first-of-its-kind group that promotes longitudinal, developmentally-based curricula in serious illness communication for all students. Convened externally by the Massachusetts Coalition for Serious Illness Care, the collaborative includes faculty, staff, and students from four medical schools. RESULTS The collaborative started with listening to member's perspectives and collectively developed core competencies in serious illness communication for implementation at each school. We share early lessons on the opportunities, challenges and sustainability of our statewide collective action to influence curricular reform, which can be replicated in other topic areas. CONCLUSIONS Our next steps include curriculum mapping, student focus groups and faculty development to guide successful and enduring implementation of the competencies to impact undergraduate medical education in Massachusetts and beyond.
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Affiliation(s)
- Jennifer A Reidy
- UMass Memorial Medical Center, 55 Lake Avenue North, Worcester, MA, 01655, USA.
- UMass Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA.
| | - Melissa A Clark
- UMass Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
- Brown University School of Public Health, 121 S Main St, Providence, RI, 02903, USA
| | - Harris A Berman
- Tufts University School of Medicine, 136 Harrison Ave, Boston, MA, 02111, USA
| | - Stephanie H Chan
- Massachusetts Coalition for Serious Illness Care, 101 Huntington Ave, Ste 1300, Boston, MA, 02199, USA
- Blue Cross Blue Shield of Massachusetts, 101 Huntington Ave, Ste 1300, Boston, MA, 02199, USA
| | - Atul A Gawande
- Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
- Ariadne Labs, 401 Park Dr, 3rd Floor, Boston, MA, 02215, USA
| | - Jocelyn Streid
- Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Tamara Vesel
- Tufts University School of Medicine, 136 Harrison Ave, Boston, MA, 02111, USA
- Tufts Medical Center, 800 Washington St, Boston, MA, 02111, USA
| | - Megan E Young
- Boston University School of Medicine, 72 E Concord St, Boston, MA, 02118, USA
| | - April Zehm
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Wauwatosa, WI, 53226, USA
- Froedtert Memorial Lutheran Hospital, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - Kristen G Schaefer
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Care Dimensions, 75 Sylvan Street, Suite B-102, Danvers, MA, 01923, USA
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Heath L, Egan R, Iosua E, Walker R, Ross J, MacLeod R. Palliative and end of life care in undergraduate medical education: a survey of New Zealand medical schools. BMC MEDICAL EDUCATION 2022; 22:530. [PMID: 35804380 PMCID: PMC9264288 DOI: 10.1186/s12909-022-03593-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 06/22/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND In New Zealand, 34% of deaths occur in the hospital setting where junior doctors are at the frontline of patient care. The death rate in New Zealand is expected to double by 2068 due to the aging population, but many studies report that graduates feel unprepared to care for people near the end of life and find this to be one of the most stressful parts of their work. International guidelines recommend that palliative and end of life care should be a mandatory component of undergraduate medical education, yet teaching varies widely and remains optional in many countries. Little is known about how medical students in New Zealand learn about this important area of clinical practice. The purpose of this study was to investigate the organisation, structure and provision of formal teaching, assessment and clinical learning opportunities in palliative and end of life care for undergraduate medical students in New Zealand. METHODS Quantitative descriptive, cross-sectional survey of module conveners in New Zealand medical schools. RESULTS Palliative and end of life care is included in undergraduate teaching in all medical schools. However, there are gaps in content, minimal formal assessment and limited contact with specialist palliative care services. Lack of teaching staff and pressure on curriculum time are the main barriers to further curriculum development. CONCLUSIONS This article reports the findings of the first national survey of formal teaching, assessment and clinical learning opportunities in palliative and end of life care in undergraduate medical education in New Zealand. There has been significant progress towards integrating this content into the curriculum, although further development is needed to address barriers and maximise learning opportunities to ensure graduates are as well prepared as possible.
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Affiliation(s)
- Lis Heath
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Richard Egan
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Ella Iosua
- Biostatistics Centre, University of Otago, Dunedin, New Zealand
| | - Robert Walker
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Jean Ross
- School of Nursing, Otago Polytechnic, Dunedin, New Zealand
| | - Rod MacLeod
- School of Population Health, University of Auckland, Auckland, New Zealand
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17
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Leppert W, Sesiuk A, Kotlińska–Lemieszek A. Current status of academic palliative medicine in Poland: a nationwide study. Palliat Care 2022; 21:100. [PMID: 35659225 PMCID: PMC9166583 DOI: 10.1186/s12904-022-00983-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 05/10/2022] [Indexed: 11/30/2022] Open
Abstract
Aim To assess the current status of palliative medicine (PM) education in medical students in Poland. Methods Data on PM teaching were obtained from a 16–item questionnaire sent to the heads of PM and palliative care (PC) departments at universities or university authorities. In cases in which there was no PM or PC department, the questionnaire was sent to authorities of a given University. Results Eleven PM and PC departments were included in the analysis; 7 at the medical universities, and four at collegium medicum at universities. Among these there were two chairs of PM (at the Medical University of Poznań and the Collegium Medicum at the University of Zielona Góra) and one chair of PC (in Bydgoszcz). Most of the Departments were part of faculties of medicine, and a minority were part of faculties of health sciences. There were no PM or PC departments at 2 medical universities, three at collegium medicum at universities, and 6 at faculties of medicine; two at public universities and 4 at non–public universities. All programs of PM teaching included the philosophy of PC, and pain management. The majority included management of other symptoms, emergencies, communication, ethical issues and psychological issues in PC. Of 12 programs, 9 included practical (bedside) teaching. The numbers of hours allocated to PM ranged from 15 to 45 (median 20). Conclusions Half of the universities that educate medical students in Poland had PM departments and provided obligatory PM teaching. Establishing departments of PM and PC at all medical universities, collegium medicum at universities, and faculties of medicine at universities with a common PM program as an integral part of undergraduate education is suggested through including PM as a separate subject to the Regulation of the Ministry of Education and Science and initiatives of National and Provincial Consultants in PM.
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18
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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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Ding J, Johnson CE, Saunders C, Licqurish S, Chua D, Mitchell G, Cook A. Provision of end-of-life care in primary care: a survey of issues and outcomes in the Australian context. BMJ Open 2022; 12:e053535. [PMID: 35046002 PMCID: PMC8772411 DOI: 10.1136/bmjopen-2021-053535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To describe general practitioners' (GPs) involvement in end-of-life care, continuity and outcomes of care, and reported management challenges in the Australian context. METHODS Sixty-three GPs across three Australian states participated in a follow-up survey to report on care provided for decedents in the last year life using a clinic-based data collection process. The study was conducted between September 2018 and August 2019. RESULTS Approximately one-third of GPs had received formal palliative care training. Practitioners considered themselves as either the primary care coordinator (53.2% of reported patients) or part of the management team (40.4% of reported patients) in the final year of care. In the last week of life, patients frequently experienced reduced appetite (80.6%), fatigue (77.9%) and psychological problems (44.9%), with GPs reporting that the alleviation of these symptoms were less than optimal. Practitioners were highly involved in end-of-life care (eg, home visits, consultations via telephone and family meetings), and perceived higher levels of satisfaction with communication with palliative care services than other external services. For one-third of patients, GPs reported that the last year of care could potentially have been improved. CONCLUSION There are continuing needs for integration of palliative care training into medical education and reforms of healthcare systems to further support GPs' involvement in end-of-life care. Further, more extensive collection of clinical data is needed to evaluate and support primary care management of end-of-life patients in general practice.
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Affiliation(s)
- Jinfeng Ding
- Xiangya School of Nursing, Central South University, Changsha, China
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Claire E Johnson
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Australian Health Service Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Christobel Saunders
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Sharon Licqurish
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - David Chua
- Primary Care Clinical Unit, University of Queensland, Brisbane, Queensland, Australia
| | - Geoffrey Mitchell
- Primary Care Clinical Unit, University of Queensland, Brisbane, Queensland, Australia
| | - Angus Cook
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
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20
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Nouhi E, Faramarzpour V, Shahrbabaki PM. Iranian nurses' educational needs and competence in palliative cancer care. Int J Palliat Nurs 2021; 27:418-426. [PMID: 34672785 DOI: 10.12968/ijpn.2021.27.8.418] [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: 11/11/2022]
Abstract
AIM This study was conducted to determine the competence and educational needs of Iranian nurses in the field of palliative cancer care. METHOD This cross-sectional study was performed on nurses working in oncology departments of hospitals in Kerman, in southeast Iran. The data were collected using nurses' core competence in palliative care inventory and a questionnaire for assessing the educational needs of nurses in the field of palliative cancer care. Pearson correlation coefficient, Independent t-test, ANOVA and Linear regression were used to examine the data. RESULTS 210 nurses participated in this study and the response rate was 98.13%. The results showed that the mean score of educational needs in palliative cancer care was 3.6±0.7. The highest average score was observed in the mental and psychological (3.83±0.89) dimensions, and the lowest in the social dimension (3.34±0.84). The mean score of nurses' competence in palliative cancer care was 1.78±0.51. The highest mean score was related to interpersonal skills (2.28±0.74), and the lowest mean score belonged to the use of Edmonton symptoms evaluation (1.10±1.27). There was a low significant and inverse correlation between nurses' competence and their educational needs. (P<0.001, r=- 0.242). CONCLUSION This study showed that Iranian nurses have the need for palliative cancer care training. Therefore, it is necessary to assign a higher priority to the evaluation of the clinical competence and educational needs of nurses in different healthcare centres.
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Affiliation(s)
- Esmat Nouhi
- Associate Professor, Nursing Research Center, Department of Medical Surgical Nursing, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Vahid Faramarzpour
- MSN, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Parvin Mangolian Shahrbabaki
- Assistant Professor, Nursing Research Center, Department of Critical Care Nursing, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
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22
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Pham M, Daddato AE, Lum HD. Assessment of Internal Medicine Resident Perspectives on Medical Aid-in-Dying in Future Practice. J Palliat Med 2021; 24:654-655. [PMID: 33945311 DOI: 10.1089/jpm.2020.0757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Michael Pham
- Internal Medicine Residency Program, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Andrea E Daddato
- Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Hillary D Lum
- Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.,VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, Colorado, USA
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Abstract
The importance of integrated palliative care in surgical oncology has been established by high-level evidence demonstrating improved patient-centered outcomes. There has been substantial improvement in efforts to incorporate palliative medicine training into medical and surgical education over the last decade. However, although trainees may feel confident in managing patients at the end of life, they may not have the insight or proficiency to provide optimal palliative care. Surgeons and palliative care physicians should collaborate on methods to optimize palliative care education for both trainees and practicing surgeons. A growing number of palliative care resources are available to this end.
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Affiliation(s)
- Alexandra C Istl
- Division of Surgical Oncology, Johns Hopkins Hospital, Blalock 684, 600 North Wolfe Street, Baltimore, MD 21287, USA. https://twitter.com/AllyIstl
| | - Fabian M Johnston
- Division of Surgical Oncology, Johns Hopkins Hospital, Blalock 684, 600 North Wolfe Street, Baltimore, MD 21287, USA.
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Kerr AM, Kachmar U, Palocko B, Biechler M, Shaub T. "Confessions of a Reluctant Caregiver" Palliative Educational Program: The Results of a Survey Assessing Physicians' Perceptions of Drama-Based Education for End-of-Life Care. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:504-507. [PMID: 31749035 DOI: 10.1007/s13187-019-01655-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Inadequate palliative care training in medical education is associated with many physicians feeling unprepared to care for dying patients and their families. Therefore, an opportunity exists to offer physicians continuing medical education that increases their understanding of and comfort with complex palliative care issues. The goal of the current study was to evaluate The Confessions of a Reluctant Caregiver Palliative Educational Program as an educational tool for physicians. The study employed a cross-sectional post-performance evaluation survey assessing physicians' perceptions of the Confessions of a Reluctant Caregiver Palliative Educational Program. The program was presented to members of four professional healthcare organizations. A total of 50 physicians completed the evaluation survey. Overall, physicians rated the Confessions of a Reluctant Caregiver Palliative Educational Program positively. Their understanding of and comfort with end-of-life issues increased significantly after participating in the program. Moreover, they considered the program to be more useful than didactic lectures and journal articles. The results suggest that the Confessions of a Reluctant Caregiver Palliative Educational Program is a valuable education tool for palliative care training. More research is needed to explore its utility as an option for continuing medical education.
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Affiliation(s)
- Anna M Kerr
- Heritage College of Osteopathic Medicine, Ohio University, 346 Grosvenor Hall, Athens, OH, 45701, USA.
| | - Ulyana Kachmar
- Heritage College of Osteopathic Medicine, Ohio University, Warrensville Heights, OH, 44122, USA
| | - Bradley Palocko
- Heritage College of Osteopathic Medicine, Ohio University, Warrensville Heights, OH, 44122, USA
| | - Merri Biechler
- College of Fine Arts, Ohio University, Athens, OH, 45701, USA
| | - Tracy Shaub
- Heritage College of Osteopathic Medicine, Ohio University, Warrensville Heights, OH, 44122, USA
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Chang T, Darshani S, Manikavasagam P, Arambepola C. Knowledge and attitudes about end-of-life decisions, good death and principles of medical ethics among doctors in tertiary care hospitals in Sri Lanka: a cross-sectional study. BMC Med Ethics 2021; 22:66. [PMID: 34039321 PMCID: PMC8152188 DOI: 10.1186/s12910-021-00631-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 05/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Competent end-of-life care is an essential component of total health care provision, but evidence suggests that it is often deficient. This study aimed to evaluate the knowledge and attitudes about key end-of-life issues and principles of good death among doctors in clinical settings. METHODS A cross-sectional study was conducted among allopathic medical doctors working in in-ward clinical settings of tertiary care hospitals in Sri Lanka using a self-administered questionnaire with open- and close-ended questions as well as hypothetical clinical scenarios. Univariate and logistic regression analysis were used to identify the independent factors associated with knowledge and attitudes. RESULTS Of the responders who had not been a caregiver for a terminally ill relative (n = 390), 57.9% were men with a mean age of 36.5 years (SD = 8.2). Compared to undergraduate (65.6%; n = 256), only 27.4% (n = 107) had received end-of-life care training at postgraduate level. Only 65.9% of doctors favoured disclosing terminal prognosis to patients; 27.7% of doctors were aware of advance directives; 14.6% were aware of the correct time of death when certifying brain death; 70.3% felt more comfortable in withholding than withdrawing life-sustaining treatment; 61.3% were aware of do-not-attempt cardiopulmonary resuscitation (DNACPR) decisions while 26.7% felt reluctant to administer it; 15.1% thought that all life-sustaining therapy should be withdrawn with a DNACPR decision; and only17.9% were able to name the four principles of medical ethics while 57.9% could not name a single. Participants scored a mean of 9.2 (SD = 3.9) of a maximum 14 points when tested on principles of a 'good death'. Doctors who had pursued postgraduate studies were more likely to be aware of breaking bad news (adjusted-Odds-Ratio:1.99; 95%CI = 1.19-3.32), advance directives (adjusted-OR: 4.15; 95%CI = 2.49-6.94), aware of certifying the correct time of death (adjusted-OR:2.37; 95%CI = 1.33-4.2) and less reluctant to make DNACPR decisions (adjusted-OR:1.74; 95%CI = 1.13-2.68). Doctors who had worked in ICU were more comfortable withholding than withdrawing treatment (adjusted-OR:1.99; 95%CI = 1.2-3.31). CONCLUSIONS Knowledge and attitudes about end-of-life care, good death and principles of medical ethics among doctors in Sri Lanka were suboptimal. Structured training of end-of-life care needs to be integrated within curricula and in-service training.
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Affiliation(s)
- Thashi Chang
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, 25, Kynsey Road, Colombo, 00800, Sri Lanka.
| | - Saumya Darshani
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, 25, Kynsey Road, Colombo, 00800, Sri Lanka
| | - Pavithra Manikavasagam
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, 25, Kynsey Road, Colombo, 00800, Sri Lanka
| | - Carukshi Arambepola
- Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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26
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Jeffers JM, Bord S, Hooper JE, Fleishman C, Cayea D, Garibaldi B. End-of-Life Care: A Multimodal and Comprehensive Curriculum for Graduating Medical Students Utilizing Experiential Learning Opportunities. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11149. [PMID: 33928187 PMCID: PMC8076371 DOI: 10.15766/mep_2374-8265.11149] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 02/26/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION End-of-life (EOL) care is an essential skill for most physicians and health care providers, yet there continues to be an educational gap in medical education literature for these skills. The Johns Hopkins School of Medicine developed the Transition to Residency, Internship, and Preparation for Life Events (TRIPLE) curriculum with the primary goal of preparing graduating medical students for life after medical school. METHODS The EOL module was one of many within the TRIPLE curriculum and consisted of two half-day sessions that targeted EOL care, death, dying, and communication skills. The first half-day session focused on a standardized patient encounter where learners initiated and completed an EOL care goals conversation around a living will. The second half-day session focused on death and dying. It included didactic sessions on organ donation, autopsy/death certificates, a simulation-based learning session on ending a resuscitation, and a standardized patient encounter where learners disclosed the death of a loved one. End-of-day and end-of-course evaluations were collected via anonymous online surveys. RESULTS In 2019, 120 students and 26 instructors participated in TRIPLE. Students rated the EOL module overall as 4.6 of 5 (SD = 0.6) and rated instructors overall as 4.6 of 5 (SD = 0.6). DISCUSSION By implementing a thorough and diverse curriculum with a variety of modalities and targeted skills, learners may be better prepared to care for patients dealing with EOL care issues. Further, the generalization of these skills may assist learners in a variety of other aspects of patient and family care.
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Affiliation(s)
- Justin M. Jeffers
- Assistant Professor, Department of Pediatrics, Division of Pediatric Emergency Medicine, Johns Hopkins University School of Medicine
| | - Sharon Bord
- Assistant Professor, Department of Emergency Medicine, Johns Hopkins University School of Medicine; Co-Director, Transition to Residency, Internship, and Preparation for Life Events (TRIPLE)
| | - Jody E. Hooper
- Associate Professor and Director of Autopsy, Department of Pathology and Oncology, Johns Hopkins University School of Medicine
| | - Carol Fleishman
- Senior Simulation Educator, Johns Hopkins Medical Simulation; Standardized Patient Lead, TRIPLE
| | - Danelle Cayea
- Associate Professor, Department of Medicine, Johns Hopkins University School of Medicine
| | - Brian Garibaldi
- Associate Professor, Department of Medicine and Physiology, Pulmonary and Critical Care, Johns Hopkins University School of Medicine; Co-Director, TRIPLE
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27
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Chen G, Hong YR, Wilkie DJ, Kittleson S, Huo J, Bian J. Geographic Variation in Knowledge of Palliative Care Among US Adults: Findings From 2018 Health Information National Trends Survey. Am J Hosp Palliat Care 2021; 38:291-299. [PMID: 32757758 PMCID: PMC7855289 DOI: 10.1177/1049909120946266] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Public knowledge and awareness of palliative care (PC) is important to its effective use. However, it remains unclear whether the geographic variation in knowledge of PC exits in the United States. This study examined the national geographic variation in knowledge of PC. METHODS The study sample was obtained from the 2018 National Cancer Institute's Health Information National Trends Survey. Basic knowledge of PC, goal concordant treatment, misconceptions, and primary information source of PC were compared across 4 census regions. Multivariable logistic regression was used to examine factors associated with awareness of PC among 9 census divisions. RESULTS A total of 3194 respondents (weighted sample size: 229 591 005) were included in this study. Overall, 29% of all respondents reported having knowledge of PC; 32.9% of those residing in Northeast had some knowledge of PC, followed by 30.8% in the South, 26.2% in Midwest, and 25.6% in West. By census divisions, respondents residing in 3 divisions were more likely to have PC knowledge (New England, odds ratio: 3.06, 95% CI: 1.48-6.32, P = .003; South Atlantic, odds ratio: 1.96, 95% CI: 1.15-3.35, P = .014; Pacific, odds ratio: 1.86, 95% CI: 1.12-3.09, P = .018) compared to those in the Mountain division. CONCLUSIONS The variation of PC knowledge on census division and state level in 2018 was consistent with the real-world geographic disparities in the availability of PC programs. These findings represent an opportunity for minimizing the gap of geographic disparity by initiating strategic programs and promoting PC programs nationwide.
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Affiliation(s)
- Guanming Chen
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Young-Rock Hong
- Department of Health Services Research, Management & Policy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Diana J. Wilkie
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, FL, USA
| | - Sheri Kittleson
- Division of Palliative Care, Department of Medicine, Gainesville, FL, USA
| | - Jinhai Huo
- US Health Economics and Outcomes Research at Bristol-Myers Squibb, Gainesville, NJ, USA
| | - Jiang Bian
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
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Parajuli J, Hupcey JE. A Systematic Review on Barriers to Palliative Care in Oncology. Am J Hosp Palliat Care 2021; 38:1361-1377. [PMID: 33412898 DOI: 10.1177/1049909120983283] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The number of people with cancer and the need for palliative care among this population is increasing in the United States. Despite this growing need, several barriers exist to the utilization of palliative care in oncology. The purpose of this study was to synthesize the evidence on the barriers to palliative care utilization in an oncology population. A systematic review of literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, CINAHL, and Psych Info databases were used for the literature search. Articles were included if they: 1) focused on cancer, (2) examined and discussed barriers to palliative care, and c) were peer reviewed, published in English, and had an accessible full text. A total of 29 studies (8 quantitative, 18 qualitative, and 3 mixed-methods) were identified and synthesized for this review. The sample size of the included studies ranged from 10 participants to 313 participants. The barriers to palliative care were categorized into barriers related to the patient and family, b) barriers related to providers, and c) barriers related to the healthcare system or policy. The factors identified in this review provide guidance for intervention development to mitigate the existing barriers and facilitate the use palliative care in individuals with cancer.
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Affiliation(s)
| | - Judith E Hupcey
- 311285The Pennsylvania State University, University Park, PA, USA
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29
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Horowitz RK, Hogan LA, Carroll T. MVP-Medical Situation, Values, and Plan: A Memorable and Useful Model for All Serious Illness Conversations. J Pain Symptom Manage 2020; 60:1059-1065. [PMID: 32738279 PMCID: PMC7390732 DOI: 10.1016/j.jpainsymman.2020.07.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/21/2020] [Accepted: 07/21/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Robert K Horowitz
- Division of Palliative Care, University of Rochester Medicine, Rochester, New York, USA.
| | - Laura A Hogan
- Division of Palliative Care, University of Rochester Medicine, Rochester, New York, USA
| | - Thomas Carroll
- Division of Palliative Care, University of Rochester Medicine, Rochester, New York, USA
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30
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Barrison P, Davidson LG. Promotion of Advance Care Planning Among Young Adults: A Pilot Study of Health Engagement Workshop Feasibility, Implementation, and Efficacy. Am J Hosp Palliat Care 2020; 38:441-447. [PMID: 32799641 DOI: 10.1177/1049909120951161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This pilot study set out to evaluate the feasibility and efficacy of an interactive, peer-led, health engagement workshop to improve confidence and comprehension related to advance care planning (ACP) among young adults. Secondarily, this study evaluated if such workshops could promote ACP related behavior changes within this population. METHODS This observational cohort study utilized a repeated measures, mixed-method design. Six hour-long, in-person workshops were conducted with undergraduate students during meetings of university student organizations. Participants were evaluated across 3 mixed-method surveys, evaluating confidence, knowledge, and behaviors related to ACP prior to participation, directly after, and during a 2-week follow-up. RESULTS Workshop participation improved the average participant confidence and knowledge related to ACP as well as encouraged some participants to engage in discussions related to end-of-life care with friends and family. Alongside the impact of the workshops on knowledge and confidence, participants positively evaluated the design of the workshops through collected qualitative feedback. CONCLUSION These results are encouraging in assessing this population's willingness to learn about end-of-life care planning. The tools developed and the corresponding results should be used for further exploration of engaging the young adult population in ACP to promote improved healthcare outcomes.
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Affiliation(s)
- Philip Barrison
- Department of Health Infrastructure and Learning Systems, 12266University of Michigan Medical School, Ann Arbor, MI, USA
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31
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Rubio L, López-García M, Gaitán-Arroyo MJ, Martin-Martin J, Santos-Amaya I. Palliative care undergraduate education: Do medical and nursing students need more skills in ethical and legal issues? Med Hypotheses 2020; 142:110138. [PMID: 32739605 DOI: 10.1016/j.mehy.2020.110138] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/20/2020] [Accepted: 07/23/2020] [Indexed: 11/29/2022]
Abstract
This study aimed to analyze the schools that teach ethical and legal aspects within the subject of palliative care in the degrees of medicine and nursing in Spain. MATERIAL AND METHODS Descriptive Analysis of the palliative care subject and their ethical and legal curricular competencies in the Spanish Nursing and Physicians undergraduate. The training received in legal ethical aspects related to palliative care was compared with the criteria established by the European Association for Palliative Care (EAPC). DATA SOURCES The National Conference of Nursing Deans, The National Conference of Spanish Medical Faculty Deans and The Ministry of Science, Innovation, and Universities databases were searched. RESULTS Twenty-one universities have an undergraduate in medicine with palliative care in their curricular training explicitly. The degree in nursing is present in fifty-six universities, palliative care is present in 62.5% of the cases. The degrees of nursing and medicine receive approximately the same level of training in ethical and legal aspects of palliative care. CONCLUSION The specific training received in ethical and legal issues of palliative care must be improved in medical and nursing to meet the EAPC levels.
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Affiliation(s)
- Leticia Rubio
- Department of Human Anatomy, Legal Medicine and History of Science. Area of Legal and Forensic Medicine, University of Malaga, Spain
| | - Mónica López-García
- Department of Human Anatomy, Legal Medicine and History of Science. Area of Legal and Forensic Medicine, University of Malaga, Spain; Fundación CUDECA Cuidados Paliativos. Cudeca Hospice. IBIMA CA-15, Spain
| | - María J Gaitán-Arroyo
- Department of Human Anatomy, Legal Medicine and History of Science. Area of Legal and Forensic Medicine, University of Malaga, Spain
| | - Jaime Martin-Martin
- Department of Human Anatomy, Legal Medicine and History of Science. Area of Legal and Forensic Medicine, University of Malaga, Spain; Biomedical Research Institute of Malaga (IBIMA), Clinometric Group (F-14), Spain.
| | - Ignacio Santos-Amaya
- Department of Human Anatomy, Legal Medicine and History of Science. Area of Legal and Forensic Medicine, University of Malaga, Spain
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32
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Weiner SB. Creating and Implementing a Resident Emotional Wellness Initiative in an Acute Care Setting: The Role of the Palliative Care Social Worker. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2020; 16:209-218. [PMID: 32240073 DOI: 10.1080/15524256.2020.1745730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Caring for dying patients is often a new experience for ICU residents. End-of-life and palliative training in medical schools is lacking. Many residents experience troublesome emotions during residency. Literature establishes that residents show lower well-being scores than similar populations. To make emotional wellness a priority for residents, monthly mandatory Palliative Care Rounds (PCR) were established in the ICU. The role of the Palliative Care Social Worker (PCSW) is central in planning and implementing PCR. Social workers have unique skills well-suited to this type of activity in an acute care setting. Residents present cases and the PCSW facilitates discussion to explore complex emotions helping residents process their feelings. Forty-five residents responded to a seven-item questionnaire, out of 70 potential resident respondents (64% response rate). Only 60% said they learned about end-of-life and its emotional aspects in medical school. Ninety-eight percent reported the PCR helped them be more aware of their feelings, and would recommend it to colleagues. Ninety-five percent said PCR are important for interns and residents to help them grow professionally and become better clinicians. Through the process of dissecting their emotions, PCR allows for personal and professional growth that improves residents' ability to become empathic providers.
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Affiliation(s)
- Sheila B Weiner
- Department of Palliative Medicine, Crozer-Chester Medical Center, Upland, PA, USA
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33
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Levy K, Grant PC, Kerr CW, Byrwa DJ, Depner RM. Hospice Patient Care Goals and Medical Students' Perceptions: Evidence of a Generation Gap? Am J Hosp Palliat Care 2020; 38:114-122. [PMID: 32588649 DOI: 10.1177/1049909120934737] [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] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The ability to perceive care goals of the dying may be an indicator of future quality patient-centered care. Research conducted on end-of-life goals indicates discrepancies between patients and physicians. OBJECTIVE The aim of this study is to compare end-of-life care goals of hospice patients and medical student perceptions of patient care goals. DESIGN Hospice patients and medical students were surveyed on their care goals and perceptions, respectively, using an 11-item survey of goals previously identified in palliative care literature. Medical student empathy was measured using the Interpersonal Reactivity Index. SETTINGS/PARTICIPANTS Eighty hospice patients and 176 medical students (97 first-year and 79 third-year) in a New York State medical school. RESULTS Medical students ranked 7 of the 11 care goals differently than hospice patients: not being a burden to family (p < .001), time with family and friends (p = .002), being at peace with God (p < .001), dying at home (p = .004), feeling that life was meaningful (p < .001), living as long as possible (p < .001), and resolving conflicts (p < .001). Third-year students were less successful than first-year students in perceiving patient care goals of hospice patients. No significant differences in medical student empathy were found based on student year. CONCLUSIONS Medical students, while empathetic, were generally unsuccessful in perceiving end-of-life care goals of hospice patients in the psychosocial and spiritual domains. Differences impeding the ability of medical students to understand these care goals may be generationally based. Increased age awareness and sensitivity may improve future end-of-life care discussions. Overall, there is a need to recognize the greater dimensionality of the dying in order to provide the most complete patient-centered care.
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Affiliation(s)
- Kathryn Levy
- Hospice & Palliative Care Buffalo, Cheektowaga, NY, USA.,Department of Planning and Research, Trocaire College, Buffalo, NY, USA
| | - Pei C Grant
- Hospice & Palliative Care Buffalo, Cheektowaga, NY, USA
| | | | - David J Byrwa
- Hospice & Palliative Care Buffalo, Cheektowaga, NY, USA.,School of Medicine, 12292University at Buffalo, the State University of New York, Buffalo, NY, USA
| | - Rachel M Depner
- Hospice & Palliative Care Buffalo, Cheektowaga, NY, USA.,Department of Counseling, School and Educational Psychology, 12292University at Buffalo, the State University of New York, Buffalo, NY, USA
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Abstract
The relationship between health care utilization and death anxiety in older adults is underexplored. This secondary analysis of the 2012 Health and Retirement Study examined health care utilization as a predictor of death anxiety in a nationally representative sample of American older adults (N = 3,960). Hierarchical binary logistic regression results revealed that overnight hospitalization, overnight nursing home placement, and outpatient visit were all statistically significant predictors of death anxiety. Outpatient visit was the strongest health care utilization predictor in the model. Increased end-of-life training for providers may improve patient-provider communication and alleviate patients' death anxiety. Future research should explore the directionality between study variables.
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Affiliation(s)
- Todd D Becker
- University of Maryland School of Social Work, Baltimore, Maryland, USA
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35
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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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36
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Gagnon B, Boyle A, Jolicoeur F, Labonté M, Taylor K, Downar J. Palliative care clinical rotations among undergraduate and postgraduate medical trainees in Canada: a descriptive study. CMAJ Open 2020; 8:E257-E263. [PMID: 32291264 PMCID: PMC7162608 DOI: 10.9778/cmajo.20190138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The number of medical undergraduate and postgraduate students completing palliative care clinical rotations in Canadian medical schools is currently unknown. The aim of this study was to assess the proportion of Canadian medical trainees completing clinical rotations in palliative care and to determine whether changes took place between 2008 and 2018. METHODS In this descriptive study, all Canadian medical schools (n = 17) were invited to provide data at the undergraduate and postgraduate levels (2007/08-2015/16 and 2007/08-2017/18, respectively). Information collected included the number, type and length of palliative care clinical rotations offered and the total number of medical trainees or residents enrolled at each school. RESULTS All 17 Canadian medical schools responded to the request for information. At the undergraduate level, palliative care clinical rotations were not offered in 2 schools, mandatory in 2 and optional in 13. Three schools that offered optional rotations were unable to provide complete data and were therefore excluded from further analyses. In 2015/16, only 29.7% of undergraduate medical students completed palliative care clinical rotations, yet this was a significant improvement compared to 2011/12 (13.6%, p = 0.02). At the postgraduate level, on average, 57.9% of family medicine trainees completed such rotations between 2007/08 and 2016/17. During the same period, palliative care clinical rotations were completed by trainees in specialty or subspecialty programs in anesthesiology (34.2%), geriatric medicine (64.4%), internal medicine (30.9%), neurology (28.2%) and psychiatry (64.5%). INTERPRETATION Between 2008 and 2018, a large proportion of Canadian medical trainees graduated without the benefit of a clinical rotation in palliative care. Without dedicated clinical exposure to palliative care, many physicians will enter practice without vital palliative care competencies.
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Affiliation(s)
- Bruno Gagnon
- Faculty of Medicine (Gagnon), Laval University; Research Centre of the Centre hospitalier universitaire de Québec-Université Laval (Gagnon, Jolicoeur, Labonté), Québec, Que.; Canadian Society of Palliative Care Physicians (Boyle, Taylor, Downar), Surrey, BC; Department of Family Medicine (Boyle), McMaster University, Hamilton, Ont.; Department of Medicine (Downar), University of Ottawa, Ottawa, Ont.
| | - Anne Boyle
- Faculty of Medicine (Gagnon), Laval University; Research Centre of the Centre hospitalier universitaire de Québec-Université Laval (Gagnon, Jolicoeur, Labonté), Québec, Que.; Canadian Society of Palliative Care Physicians (Boyle, Taylor, Downar), Surrey, BC; Department of Family Medicine (Boyle), McMaster University, Hamilton, Ont.; Department of Medicine (Downar), University of Ottawa, Ottawa, Ont
| | - Fabienne Jolicoeur
- Faculty of Medicine (Gagnon), Laval University; Research Centre of the Centre hospitalier universitaire de Québec-Université Laval (Gagnon, Jolicoeur, Labonté), Québec, Que.; Canadian Society of Palliative Care Physicians (Boyle, Taylor, Downar), Surrey, BC; Department of Family Medicine (Boyle), McMaster University, Hamilton, Ont.; Department of Medicine (Downar), University of Ottawa, Ottawa, Ont
| | - Mauranne Labonté
- Faculty of Medicine (Gagnon), Laval University; Research Centre of the Centre hospitalier universitaire de Québec-Université Laval (Gagnon, Jolicoeur, Labonté), Québec, Que.; Canadian Society of Palliative Care Physicians (Boyle, Taylor, Downar), Surrey, BC; Department of Family Medicine (Boyle), McMaster University, Hamilton, Ont.; Department of Medicine (Downar), University of Ottawa, Ottawa, Ont
| | - Kim Taylor
- Faculty of Medicine (Gagnon), Laval University; Research Centre of the Centre hospitalier universitaire de Québec-Université Laval (Gagnon, Jolicoeur, Labonté), Québec, Que.; Canadian Society of Palliative Care Physicians (Boyle, Taylor, Downar), Surrey, BC; Department of Family Medicine (Boyle), McMaster University, Hamilton, Ont.; Department of Medicine (Downar), University of Ottawa, Ottawa, Ont
| | - James Downar
- Faculty of Medicine (Gagnon), Laval University; Research Centre of the Centre hospitalier universitaire de Québec-Université Laval (Gagnon, Jolicoeur, Labonté), Québec, Que.; Canadian Society of Palliative Care Physicians (Boyle, Taylor, Downar), Surrey, BC; Department of Family Medicine (Boyle), McMaster University, Hamilton, Ont.; Department of Medicine (Downar), University of Ottawa, Ottawa, Ont
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Kerr AM, Biechler M, Kachmar U, Palocko B, Shaub T. Confessions of a Reluctant Caregiver Palliative Educational Program: Using Readers' Theater to Teach End-of-Life Communication in Undergraduate Medical Education. HEALTH COMMUNICATION 2020; 35:192-200. [PMID: 30477344 DOI: 10.1080/10410236.2018.1550471] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
End-of-life care can be stressful for patients, caregivers, and providers. Caregivers often experience high levels of burden from caregiving duties such as performing medical tasks, communicating with providers, and making decisions. Similarly, many physicians feel unprepared to provide end-of-life care or communicate with patients and families about sensitive issues associated with death and dying. Physicians often attribute their lack of preparation to inadequate training in medical school. Previous research suggests that drama-based learning opportunities are valuable supplements to existing end-of-life curricula. The current study evaluates the success of the Confessions of a Reluctant Caregiver Palliative Educational Program - a drama-based educational program that depicts patient and caregiver experiences. A total of 477 osteopathic medical students participated in the program, which includes viewing a play, engaging in a facilitated post-performance talkback session, and completing an evaluation survey. The results suggest the program is a valuable learning experience that is positively associated with important facets of experiential learning using narratives such as perceived realism, increased reflection, strong emotions, and increased comfort with difficult behaviors. The program offers a safe environment for medical students to identify, understand, and process the sensitive and complex issues associated with end-of-life care. Moreover, the play offers insight into the often-overlooked experiences of family caregivers who are at risk of experiencing high caregiver burden while managing health-related communication and decision-making.
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Affiliation(s)
- Anna M Kerr
- Department of Family Medicine, Heritage College of Osteopathic Medicine, Ohio University
| | - Merri Biechler
- School of Dance, Film, and Theater, College of Fine Arts, Ohio University
| | - Ulyana Kachmar
- Heritage College of Osteopathic Medicine, Ohio University
| | | | - Tracy Shaub
- Department of Family Medicine, Heritage College of Osteopathic Medicine, Ohio University
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Trankle SA, Shanmugam S, Lewis E, Nicholson M, Hillman K, Cardona M. Are We Making Progress on Communication with People Who Are Near the End of Life in the Australian Health System? A Thematic Analysis. HEALTH COMMUNICATION 2020; 35:158-167. [PMID: 30475078 DOI: 10.1080/10410236.2018.1548335] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Initiating end-of-life (EoL) discussions with patients is often delayed or avoided altogether by healthcare practitioners even in light of imminent death. This continues despite the availability of guidelines and conceptual frameworks on how to communicate prognoses at EoL. We surveyed healthcare practitioners to elicit their exposure to and confidence in EoL discussions and to better understand factors that enable or challenge the initiation of discussions in Australian healthcare settings. Thematic analysis identified that EoL discussions could be emotionally burdensome for healthcare practitioners but were regarded as valuable. Effective communications were challenged by conflict with families and between healthcare practitioners as to appropriate care goal transition, and by prognostic uncertainty. Communication skills appeared to be developed more from experience, and beneficial strategies such as role play and mentoring particularly for younger nurses and doctors were identified. Specific training in EoL communications should target undergraduates and new healthcare practitioners.
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Affiliation(s)
- Steven A Trankle
- Department of General Practice, School of Medicine, Western Sydney University
| | | | - Ebony Lewis
- School of Public Health and Community Medicine, The University of New South Wales
| | | | - Ken Hillman
- Intensive Care Unit, Liverpool Hospital
- The Simpson Centre for Health Services Research, South Western Sydney Clinical School, The University of New South Wales
| | - Magnolia Cardona
- Centre for Research in Evidence Based Practice, Faculty of Health Sciences and Medicine Bond University
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Klufas A, Shin G, Raphael R, Sarfaty SC, Hirsch AE. A Thorough Analysis of the Current State of Cancer Education in Medical Schools and Application of Experimental Teaching Techniques and Their Efficacy. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2020; 11:931-946. [PMID: 33293885 PMCID: PMC7719335 DOI: 10.2147/amep.s268382] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/08/2020] [Indexed: 05/12/2023]
Abstract
Newly diagnosed cases of cancer are expected to double by the year 2040. Although many different oncology teaching initiatives have been implemented, many students continue to report uncertainty when dealing with patients with cancer. Through this review, we aim to find the most effective teaching methods to better prepare future physicians. Papers studying different methods of teaching oncology were identified through a thorough review of specific electronic databases. Each study was analyzed and sorted into one of ten unique categories created by the authors specifically for this review. If portions of the study fit into multiple categories, relevant results would be analyzed in all applicable areas. Additionally, papers were separated and analyzed by country of origin, preclinical or clinical interventional basis, and quantitative versus qualitative form of statistical analysis. A total of 115 papers from 26 different countries and regions were included in the final analysis. 91.4% of papers analyzing Lecture and Small Group Discussions indicated a positive impact. 97.1% of papers analyzing Clinical Practice and Simulation indicated a positive impact. 100% of papers analyzing Early Experience and Mentorship, Summer Programs and Voluntary Electives, use of Multidisciplinary Teams, and Role Play stated that these methods had a positive impact. 50% of papers analyzing Computer/Web Based Programs indicated a positive impact. Clinical Practice and Simulation, Role Play, Summer/Elective Programs and interventions involving Multidisciplinary Team Work all appeared to be most effective. Intensive Block Programs, Didactic Lectures/Small Group Discussions, and Computer/Web Based Education tools as a whole were variable. General Review papers showed continued variability in domestic and international oncology curricula. Incorporation of effective teaching interventions should be highly considered in the future creation of standardized oncology curricula in order to best prepare the next generation of physicians. Future studies could explore the differing efficacies of teaching interventions in the postgraduate versus graduate realms.
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Affiliation(s)
- Andrew Klufas
- Boston University School of Medicine, Boston, MA, USA
| | - Grace Shin
- Boston University School of Medicine, Boston, MA, USA
| | - Ryan Raphael
- Boston University School of Medicine, Boston, MA, USA
| | - Suzanne C Sarfaty
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Ariel E Hirsch
- Department of Radiation Oncology, Boston Medical Center, Boston, MA, USA
- Department of Radiation Oncology, Boston University School of Medicine, Boston, MA, USA
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40
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Sorensen A, Le LW, Swami N, Hannon B, Krzyzanowska MK, Wentlandt K, Rodin G, Zimmermann C. Readiness for delivering early palliative care: A survey of primary care and specialised physicians. Palliat Med 2020; 34:114-125. [PMID: 31849272 DOI: 10.1177/0269216319876915] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Evidence supporting early palliative care is based on trials of specialised palliative care, but a more sustainable model might involve mainly primary providers. AIM The aim of this study was to compare the characteristics of physicians providing primary and specialised palliative care, their attitudes towards early palliative care and their perception of having sufficient resources for its provision. DESIGN Survey distributed by mail and e-mail. Specialised providers were defined as both receiving palliative care referrals from other physicians and not providing palliative care only for their own patients. SETTING/PARTICIPANTS A total of 531 physicians providing palliative care in Canada (71% participation) participated in the study. RESULTS Of the participants, 257 (48.4%) provided specialised and 274 (51.6%) primary care. Specialists were more likely to have palliative care training (71.8% vs 35.2%), work in urban areas (94.1% vs 75.6%), academic centres (47.8% vs 26.0%) and on teams (82.4% vs 16.8%), and to provide mainly cancer care (84.4% vs 65.1%) (all p < 0.001). Despite strongly favouring early palliative care, only half in each group agreed they had resources to deliver it; agreement was stronger among family physicians, those working on teams and those with greater availability of community and psychosocial support. Primary providers were more likely to agree that renaming the specialty 'supportive care' would increase patient comfort with early palliative care referral (47.4% vs 35.5%, p < 0.001). CONCLUSION Despite strongly favouring the concept, both specialists and primary providers lack resources to deliver early palliative care; its provision may be facilitated by team-based care with appropriate support. Opinions differ regarding the value of renaming palliative care.
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Affiliation(s)
- Anna Sorensen
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Wisconsin, Madison, WI, USA
| | - Lisa W Le
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Nadia Swami
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Breffni Hannon
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Monika K Krzyzanowska
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Kirsten Wentlandt
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
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Zens TJ, Kopecky KE, Schwarze ML, Suwanabol PA. Surgery Hurts: Characterizing the Experience of Pain in Surgical Patients as Witnessed by Medical Students. JOURNAL OF SURGICAL EDUCATION 2019; 76:1506-1515. [PMID: 31060970 DOI: 10.1016/j.jsurg.2019.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 03/16/2019] [Accepted: 04/16/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND The patient experience around surgical care is poorly characterized. Medical students have a unique position on the surgical team, which allows them to observe patient experiences that may otherwise be overlooked. The objective of this study was to characterize surgical patients' experience with pain as witnessed by medical students. STUDY DESIGN At the end of an 8-week surgical clerkship, we asked all third-year medical students to write a reflective essay describing one surgical patient in pain. We collected 341 essays over a 4-year period and used qualitative content analysis to explore the students' reports of pain experienced by surgical patients. RESULTS When asked to tell a story about a surgical patient in pain, medical students report vivid descriptions of physical agony, emotional distress, and patient regret. For example, "Throughout the procedure our patient cried out and writhed in agony from the searing pain in his chest," and "The patient was practically shedding tears, complaining of pain, as [we] changed her dressing." The students' accounts reveal wide-ranging physical and emotional suffering among surgical patients, including alterations in self-image and feelings of vulnerability. Pain and suffering were intensified when patients felt they had lost control, in settings of uncertain prognosis and with unexpected outcomes. CONCLUSIONS Students' descriptions of the surgical patient's experience are disturbingly graphic. They expose suffering ranging from generalized discomfort to anguish and excruciating pain. These data suggest that surgical patients have substantial unmet needs with respect to symptom management and emotional support that, if better addressed, could improve the patient experience.
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Affiliation(s)
- Tiffany J Zens
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Kimberly E Kopecky
- Department of Surgery, Stanford University, Stanford, California; Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Margaret L Schwarze
- Department of Surgery, University of Wisconsin, Madison, Wisconsin; Department of Medical History and Bioethics, University of Wisconsin, Madison, Wisconsin
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Carey ML, Zucca AC, Freund MA, Bryant J, Herrmann A, Roberts BJ. Systematic review of barriers and enablers to the delivery of palliative care by primary care practitioners. Palliat Med 2019; 33:1131-1145. [PMID: 31630630 DOI: 10.1177/0269216319865414] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND There is increasing demand for primary care practitioners to play a key role in palliative care delivery. Given this, it is important to understand their perceptions of the barriers and enablers to optimal palliative care, and how commonly these are experienced. AIM To explore the type and prevalence of barriers and enablers to palliative care provision reported by primary care practitioners. DESIGN A systematic review of quantitative data-based articles was conducted. DATA SOURCES Medline, Embase and PsychINFO databases were searched for articles published between January 2007 and March 2019. DATA SYNTHESIS Abstracts were assessed against the eligibility criteria by one reviewer and a random sample of 80 articles were blind coded by a second author. Data were extracted from eligible full-texts by one author and checked by a second. Given the heterogeneity in the included studies' methods and outcomes, a narrative synthesis was undertaken. RESULTS Twenty-one studies met the inclusion criteria. The most common barriers related to bureaucratic procedures, communication between healthcare professionals, primary care practitioners' personal commitments, and their skills or confidence. The most common enablers related to education, nurses and trained respite staff to assist with care delivery, better communication between professionals, and templates to facilitate referral to out-of-hours services. CONCLUSION A holistic approach addressing the range of barriers reported in this review is needed to support primary care providers to deliver palliative care. This includes better training and addressing barriers related to the interface between healthcare services.
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Affiliation(s)
- Mariko L Carey
- Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Health Behaviour Research Collaborative, The University of Newcastle, Callaghan, NSW, Australia
| | - Alison C Zucca
- Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Health Behaviour Research Collaborative, The University of Newcastle, Callaghan, NSW, Australia
| | - Megan Ag Freund
- Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Health Behaviour Research Collaborative, The University of Newcastle, Callaghan, NSW, Australia
| | - Jamie Bryant
- Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Health Behaviour Research Collaborative, The University of Newcastle, Callaghan, NSW, Australia
| | - Anne Herrmann
- Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Health Behaviour Research Collaborative, The University of Newcastle, Callaghan, NSW, Australia
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44
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Tyacke MH, Guttormson JL, Garnier-Villarreal M, Schroeter K, Peltier W. Advance directives and intensity of care delivered to hospitalized older adults at the end-of-life. Heart Lung 2019; 49:123-131. [PMID: 31492522 DOI: 10.1016/j.hrtlng.2019.08.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 06/30/2019] [Accepted: 08/20/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Older adults prefer comfort over life-sustaining care. Decreased intensity of care is associated with improved quality of life at the end-of-life (EOL). OBJECTIVES This study explored the association between advance directives (ADs) and intensity of care in the acute care setting at the EOL for older adults. METHODS A retrospective, correlational study of older adult decedents (N = 496) was conducted at an academic medical center. Regression analyses explored the association between ADs and intensity of care. RESULTS Advance directives were not independently predictive of aggressive care but were independently associated with referrals to palliative care and hospice; however, effect sizes were small, and the timing of referrals was late. CONCLUSION The ineffectiveness of ADs to reduce aggressive care or promote timely referrals to palliative and hospice services, emphasizes persistent inadequacies related to EOL care. Research is needed to understand if this failure is provider-driven or a flaw in the documents themselves.
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Affiliation(s)
- Marsha H Tyacke
- Marquette University, College of Nursing, PO Box 1881, Milwaukee, WI 53201, United States.
| | - Jill L Guttormson
- Marquette University, College of Nursing, PO Box 1881, Milwaukee, WI 53201, United States.
| | | | - Kathryn Schroeter
- Marquette University, College of Nursing, PO Box 1881, Milwaukee, WI 53201, United States.
| | - Wendy Peltier
- Medical College of Wisconsin, CLCC, Clinical Cancer Center, 9200 W Wisconsin Ave, Milwaukee, WI 53226, United States.
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Stepanyan KD, Weiss TE, Pessegueiro AM, Pietras CJ. Lessons From the Development and Implementation of a Palliative Care Elective for Fourth-Year Medical Students: A Pilot Study. Am J Hosp Palliat Care 2019; 37:191-195. [PMID: 31476883 DOI: 10.1177/1049909119872976] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Although palliative care is recognized as an important component of medical school curricula, the content and structure of education in the field is variable and often lacks outpatient exposure. We aimed to develop and implement a palliative care clinical elective for fourth-year medical students incorporating both inpatient and outpatient learning. METHODS Fourteen medical students participated in a palliative care elective which included 2 weeks on an inpatient consult service and 1 week of outpatient clinic and home hospice visits. The elective was evaluated using a focus group and previously validated surveys assessing self-rated competency and attitudes toward caring for palliative care patients. Data were analyzed using paired t tests to compare survey response means before and after the elective. RESULTS Of the 14 participating students, 7 completed both the pre- and postelective surveys. Significant improvements in self-rated competency were seen in pain and symptom management (P < .001), communication (P < .001), and advance care planning (P < .01). Survey results also showed improvement in attitudes toward caring for dying patients (P < .001), with lower scores at the end of the elective suggesting reduced emotional distress. Although the outpatient component was hypothesized to be a major benefit of the curriculum, qualitative data revealed the most highly valued component to be direct observation and feedback during inpatient time. CONCLUSION Given the highlighted importance of direct observation and feedback as a unique and powerful learning experience, future work should be targeted toward enhancing the quality and timeliness of feedback delivered by the palliative care interdisciplinary team.
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46
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McMahon D, Wee B. Medical undergraduate palliative care education (UPCE). BMJ Support Palliat Care 2019; 11:4-6. [DOI: 10.1136/bmjspcare-2019-001965] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 07/17/2019] [Indexed: 11/03/2022]
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Rumpold T, Lütgendorf-Caucig C, Löffler-Stastka H, Roider-Schur S, Pötter R, Kirchheiner K. Attitude Towards End of Life Communication of Austrian Medical Students. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:743-748. [PMID: 29687186 DOI: 10.1007/s13187-018-1366-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Medical students have to acquire theoretical knowledge, practical skills, and a personal attitude to meet the emerging needs of palliative care. The present study aimed to assess the personal attitude of Austrian medical students towards end of life communication (EOLC), as key part of palliative care. This cross-sectional, mono-institutional assessment invited all medical students at the Medical University of Vienna in 2015. The assessment was conducted web-based via questionnaire about attitudes towards EOLC. Additional socio-demographic and medical education-related parameters were collected. Overall, 743 medical students participated in the present report. Differences regarding the agreement or disagreement to several statements concerning the satisfaction of working with chronically ill patients, palliative care, and health care costs, as well as the extent of information about palliative disease, were found for age, gender, and academic years. The overall attitude towards EOLC in the present sample can be regarded as quite balanced. Nevertheless, a considerable number of medical students are still reluctant to inform patients about their incurable disease. Reservations towards palliative care as part of the health care system seem to exist. The influence of the curriculum as well as practical experiences seems to be important but needs further investigation.
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Affiliation(s)
- Tamara Rumpold
- Department of Radiation Oncology, Comprehensive Cancer Center Medical University of Vienna, Waehringer Straße 18-20, 1090, Vienna, Austria
| | | | - Henriette Löffler-Stastka
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Straße 18-20, 1090, Vienna, Austria
| | - Sophie Roider-Schur
- Division of Palliative Care, Department of Internal Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Straße 18-20, 1090, Vienna, Austria
| | - Richard Pötter
- Department of Radiation Oncology, Comprehensive Cancer Center Medical University of Vienna, Waehringer Straße 18-20, 1090, Vienna, Austria
| | - Kathrin Kirchheiner
- Department of Radiation Oncology, Comprehensive Cancer Center Medical University of Vienna, Waehringer Straße 18-20, 1090, Vienna, Austria
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Huo J, Hong YR, Grewal R, Yadav S, Heller IW, Bian J, Wilkie DJ. Knowledge of Palliative Care Among American Adults: 2018 Health Information National Trends Survey. J Pain Symptom Manage 2019; 58:39-47.e3. [PMID: 30922703 DOI: 10.1016/j.jpainsymman.2019.03.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 03/14/2019] [Accepted: 03/18/2019] [Indexed: 10/27/2022]
Abstract
CONTEXT Palliative care will play an important role to alleviate disease suffering and improve quality of life for cancer patients and their family caregivers. OBJECTIVE We examined the knowledge penetration of palliative care in a nationally representative sample of U.S. adults. METHODS We used the 2018 National Cancer Institute's Health Information National Trends Survey to determine the proportion of respondents who had knowledge of palliative care as well as the depth and sources of their knowledge. We used the Pearson chi-square test and a multivariable logistic regression model to assess the association of respondents' basic demographic characteristics as well as health status and having knowledge of palliative care. RESULTS We identified 3194 respondents (weighted sample size: 229,591,005) who met the inclusion criteria. About 71% (2097) of all respondents had no knowledge of palliative care and 84.5% of Hispanic respondents had no knowledge of palliative care. Multivariable analyses indicated the middle-aged (50-64 years old, odds ratio, 1.58; 95% CI, 1.15-2.19, P = 0.006) and elder population (65 years or older, odds ratio, 1.70, 95% CI, 1.30-2.22, P < 0.001) have a significantly better knowledge of palliative care than those under age 50. Common misconceptions existed in respondents, even those who had self-reported adequate knowledge of palliative care. CONCLUSION The proportion of adults who have knowledge of palliative care is low in the U.S. Greater efforts are needed to promote palliative care and reduce the misconceptions of palliative care in the general population.
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Affiliation(s)
- Jinhai Huo
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA.
| | - Young-Rock Hong
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Reetu Grewal
- Department of Community Health and Family Medicine, College of Medicine, University of Florida, Jacksonville, Florida, USA
| | - Sandhya Yadav
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Isaac W Heller
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Jiang Bian
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Diana J Wilkie
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida, USA
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Abstract
BACKGROUND Building palliative care capacity among all healthcare practitioners caring for patients with chronic illnesses, who do not work in specialist palliative care services (non-specialist palliative care), is fundamental in providing more responsive and sustainable palliative care. Varying terminology such as 'generalist', 'basic' and 'a palliative approach' are used to describe this care but do not necessarily mean the same thing. Internationally, there are also variations between levels of palliative care which means that non-specialist palliative care may be applied inconsistently in practice because of this. Thus, a systematic exploration of the concept of non-specialist palliative care is warranted. AIM To advance conceptual, theoretical and operational understandings of and clarity around the concept of non-specialist palliative care. DESIGN The principle-based method of concept analysis, from the perspective of four overarching principles, such as epistemological, pragmatic, logical and linguistic, were used to analyse non-specialist palliative care. DATA SOURCES The databases of CINAHL, PubMed, PsycINFO, The Cochrane Library and Embase were searched. Additional searches of grey literature databases, key text books, national palliative care policies and websites of chronic illness and palliative care organisations were also undertaken. CONCLUSION Essential attributes of non-specialist palliative care were identified but were generally poorly measured and understood in practice. This concept is strongly associated with quality of life, holism and patient-centred care, and there was blurring of roles and boundaries particularly with specialist palliative care. Non-specialist palliative care is conceptually immature, presenting a challenge for healthcare practitioners on how this clinical care may be planned, delivered and measured.
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Affiliation(s)
- Mary Nevin
- School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, Ireland
| | - Valerie Smith
- School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, Ireland
| | - Geralyn Hynes
- School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, Ireland
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Van Scoy LJ, Green MJ, Volpe R. Evaluating an Advance Care Planning Curriculum: a Lecture, a Game, a Patient, and an Essay. MEDICAL SCIENCE EDUCATOR 2019; 29:453-462. [PMID: 34457502 PMCID: PMC8368620 DOI: 10.1007/s40670-019-00713-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE Curricula on advance care planning are commonly absent or inadequate in the majority of medical schools. This study assessed an advance care planning mini-curriculum involving a lecture, an end-of-life conversation game, a patient encounter during which students facilitated completion of an advance directive, and a subsequent reflective essay. METHODS This convergent, mixed methods study used a pre-post, longitudinal design. Confidence having end-of-life conversations was assessed at three timepoints. A linear mixed effects model compared mean confidence at the three timepoints. Focus groups and open-ended questionnaires (analyzed using content analysis) explored student perceptions of the curricula. RESULTS Sixty-nine of 149 students completed the questionnaires; 18 students participated in the focus groups. Confidence scores increased by 10.3 points (+ 4.2 post-lecture/game; + 6.1 post-patient assignment/essay; p < 0.001 for all timepoints). Students felt the game (1) was a good "starting point" for learning to initiate end-of-life conversations; (2) fostered internal and external reflections about advance care planning; and (3) allowed exploration of the complexities of end-of-life discussions. Qualitative exploration suggested that high-level learning-interpreted through the lens of Bloom's taxonomy-occurred. CONCLUSION Mixed methods data suggest that the advance care planning mini-curriculum effectively increased student confidence having end-of-life conversations. Qualitative analyses revealed student learning covering all of tiers of Bloom's taxonomy.
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Affiliation(s)
- Lauren Jodi Van Scoy
- Medicine, Humanities and Public Health Sciences, Pennsylvania State University College of Medicine, 500 University Drive, H041, PO Box 850, Hershey, PA 17033 USA
| | - Michael J. Green
- Humanities and Medicine, Pennsylvania State University College of Medicine, 500 University Drive, PO Box 850, Hershey, PA 17033 USA
| | - Rebecca Volpe
- Humanities, Pennsylvania State University College of Medicine, 500 University Drive, PO Box 850, Hershey, PA 17033 USA
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