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Harhara T, Buhumaid R, Oyoun Alsoud L, Ibrahim H. Palliative care education: a nationwide qualitative study of emergency medicine residency program directors in the United Arab Emirates. Int J Emerg Med 2024; 17:69. [PMID: 38783214 PMCID: PMC11119274 DOI: 10.1186/s12245-024-00643-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 05/04/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Emergency medicine (EM) physicians routinely care for patients with serious life-limiting illnesses. Educating EM residents to have general skills and competencies in palliative medicine is a global priority. The purpose of this study was to describe the current status of palliative and end-of-life education in EM residency programs in the United Arab Emirates (UAE) and to identify barriers and opportunities to inculcating palliative care (PC) instruction into EM training in a non-Western setting. METHODS Using the American College of Emergency Medicine's milestones for Hospice and Palliative Medicine for Emergency Medicine as a question guide, semi-structured interviews were conducted with program directors of all 7 EM residency programs in the UAE from January through July 2023. Qualitative content analysis was conducted to identify recurring themes. RESULTS All program directors agreed that PC knowledge and skills are essential components of training for EM residents but have had variable success in implementing a structured PC curriculum. Six themes emerged, namely the educational curriculum, PC policies and practices, comprehensive PC services, cultural and religious barriers to PC, EM scope of practice, and supporting residents after patient death. CONCLUSION UAE national EM residency curriculum development is evolving with an emphasis on developing a structured PC curriculum. As EM residencies implement policies and programs to improve care for patients and families dealing with serious illness, future studies are needed to assess the impact of these initiatives on patient quality of life and physician well-being.
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Affiliation(s)
- Thana Harhara
- Department of Medicine, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Rasha Buhumaid
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
- Department of Emergency Medicine, Rashid Hospital, Dubai Health, Dubai, United Arab Emirates
| | - Leen Oyoun Alsoud
- Department of Medical Sciences, Khalifa University College of Medicine and Health Sciences, Abu Dhabi, United Arab Emirates
| | - Halah Ibrahim
- Department of Medical Sciences, Khalifa University College of Medicine and Health Sciences, Abu Dhabi, United Arab Emirates.
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Sadigh N, Seyedhosseini J, Tahmasebi M, Shirani F. Attitude toward end-of-life care in emergency medicine residents- can a short workshop make a difference? PLoS One 2023; 18:e0280229. [PMID: 36630421 PMCID: PMC9833511 DOI: 10.1371/journal.pone.0280229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 12/25/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND There is a growing demand for palliative care (PC) in Emergency departments (ED) as the number of patients who need end-of-life (EOL) care is increasing. Despite significant variability amongst residency programs, there is a lack of structured core curriculum for PC/EOL care in most emergency medicine (EM) training programs, which often do not meet the needs of EM physicians. In this study, we evaluate the effect of a short EOL care workshop on changing the attitude of Iranian EM residents towards EOL care in ED. METHOD In this prospective before/after educational study at Tehran University of medical science, we enrolled 40 EM residents using a random sampling method. We obtained demographic and practice background information, and participants underwent a half-day PC training workshop designed by an expert panel. We administered a translated and validated Standard PEAS (physician End of Life Care Attitude Scale) questionnaire before and four weeks after an educational intervention. Baseline and differences in attitude were reported and compared by paired t-test, repeated measure ANOVA, and ANOVA. RESULTS None of the participants had prior experience of formal PC training. All of the 40 participants completed the follow-up questionnaire. Baseline attitude was not different among demographic groups. The mean (SD) PEAS score before and four weeks after the workshop was 86.9 (5.8) versus 89(6.9), respectively (P = 0.023). Residents with no previous close exposure to a terminal illness in their family members had significantly more attitude change than those with such an experience (P = 0.045). CONCLUSION A brief educational intervention improved EM residents' attitudes toward EOL care. The optimal design and characteristics of this educational intervention yet remain to be defined by further studies.
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Affiliation(s)
- Nader Sadigh
- Department of Emergency Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Emergency Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Javad Seyedhosseini
- Department of Emergency Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mamak Tahmasebi
- Radiotherapy/Oncology Department, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzaneh Shirani
- Department of Emergency Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- * E-mail:
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Crock B, Islam MR, Subramaniam S. Emergency Department Utilisation by Palliative Patients in a Regional Australian Setting. Am J Hosp Palliat Care 2021; 39:956-961. [PMID: 34866425 DOI: 10.1177/10499091211055903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Many palliative care patients attend emergency departments (EDs) in acute Hospital. However, very limited studies inform about their presentations and appropriateness. OBJECTIVES This study explored the reasons and appropriateness of palliative care presentations in a regional Australian ED setting. METHODS A retrospective, single-centre observational study was conducted in a regional Australian hospital. All patients between January and December 2018 known to palliative care services presented to ED were included. Appropriateness of presentations was determined based on urgency of tests and treatments received, and practicability of obtaining these in a different setting. RESULTS A total of 35 patients made 85 presentations to the ED in 2018. The most common individual presenting complaints were shortness of breath (18.9%) followed by pain (14.1%), fever (11.8%), fall (8.2%), reduced oral intake or dehydration (8.2%), and bleeding (8.2%). The patients were brought by an ambulance in 56.5% presentations, and 63.5% presentations were admitted. About 93% presentations were referred by community healthcare professionals or required urgent investigation or management. CONCLUSIONS This study found the majority of presentations were appropriate since their management could not be delivered at other primary care settings. This study adds value to the growing body of evidence and supports future multi-site longitudinal studies.
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Affiliation(s)
- Ben Crock
- 72544Goulburn Valley Health, Shepparton, Victoria, Australia
| | - Md Rafiqul Islam
- 72544Goulburn Valley Health, Shepparton, Victoria, Australia.,Department of Rural Health, The University of Melbourne, Shepparton, Victoria, Australia.,Rural Health School, College of Science, Health and Engineering, La Trobe University, Shepparton, Victoria, Australia
| | - Sivakumar Subramaniam
- 72544Goulburn Valley Health, Shepparton, Victoria, Australia.,Department of Rural Health, The University of Melbourne, Shepparton, Victoria, Australia
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Rawlings D, Devery K, Poole N. Improving quality in hospital end-of-life care: honest communication, compassion and empathy. BMJ Open Qual 2019; 8:e000669. [PMID: 31259290 PMCID: PMC6567943 DOI: 10.1136/bmjoq-2019-000669] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 05/14/2019] [Accepted: 05/16/2019] [Indexed: 11/03/2022] Open
Abstract
Background With over half of expected deaths occurring in acute hospitals, and a workforce not trained to care for them, good quality end-of-life care in these settings is hard to achieve. The National Consensus Statement on Essential Elements for Safe and High-Quality End-of-Life Care has been translated into e-learning modules by the End of Life Essentials project, and this study aims to demonstrate how clinicians interpret the Consensus Statement in their day-to-day practice by answering the question at the end of each module: 'Tomorrow, the one thing I can change to more appropriately provide end-of-life care is…'. Methods The modules were developed by a palliative care educator with the support of a peer review group and were piloted with 35 health professionals. Pre-post module evaluation data were collected and during a 10-month period from 2016 to 2017 a total of 5181 individuals registered for the project accessing one or more of the six modules. The data from 3201 free-text responses to the post hoc practice change question have been analysed, and themes generated. Findings Five themes are derived from the data: communication, emotional insight, professional mindset, person-centred care and professional practice. Conclusion Learners who have completed End of Life Essentials have shared the ways they state they can change their practice tomorrow which may well be appreciated as a clinical response to the work by the Australian Commission on Safety and Quality in Health Care in leading and coordinating national improvements in quality and safety in healthcare in Australia. While intent cannot guarantee practice change, theory on intention-behaviour relations indicate that intentions have a strong association with behaviour. This indicates that the modules have the ability to influence end-of-life care in acute hospitals.
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Affiliation(s)
- Deb Rawlings
- Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia
| | - Kim Devery
- Palliative and Supportive Services, Flinders University Faculty of Medicine, Nursing and Health Sciences, Adelaide, South Australia, Australia
| | - Naomi Poole
- Director, Partnering with Consumers, Australian Commission on Safety and Quality in Health Care, Sydney, New South Wales, Australia
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Philip J, Remedios C, Breen S, Weiland T, Willenberg L, Boughey M, Jelinek G, Lane H, Marck C, Weil J. The experiences of patients with advanced cancer and caregivers presenting to Emergency Departments: A qualitative study. Palliat Med 2018; 32:439-446. [PMID: 29130378 DOI: 10.1177/0269216317735724] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Despite being a common event in the course of an advanced cancer illness, there is little understanding of patients' perceptions of hospital Emergency Department presentations. AIM To explore the experiences and perceptions of Emergency Departments held by patients with advanced cancer and their informal caregivers. DESIGN Cross-sectional study involving semi-structured interviews with advanced cancer patients and their informal caregivers. Qualitative data analysis was underpinned by a phenomenological approach utilising a data-driven inductive thematic frame. SETTING/PARTICIPANTS In total, 19 patients with advanced cancer who presented to Emergency Departments in the previous 6 months and 10 informal caregivers from an Australian public hospital and community palliative care service were interviewed. RESULTS Patients reported that Emergency Department presentations were largely prompted by worsening symptoms or were a means to expedite hospital admission, with many instructed to attend by their health care provider. The experience in the Emergency Department was described as a time of anxiety and uncertainty with concerns over communication, the general environment and delays in the symptom management highlighted. Long waits were common. Despite this, patients described relief at receiving care. While the Emergency Department was viewed as a safety net for the health system, many believed advanced cancer patients should have alternative options. CONCLUSION Relatively simple changes of regular communication updates and early symptom relief would improve patient experience of Emergency Department care. However, since an Emergency Department presentation is frequently serving as a default to access medical care, a significant re-orientation of the health care system is required to meet patient needs.
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Affiliation(s)
- Jennifer Philip
- 1 Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia.,2 Victorian Comprehensive Cancer Centre, Parkville, VIC, Australia.,3 Palliative Medicine, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | | | - Sibilah Breen
- 1 Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Tracey Weiland
- 5 Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Mark Boughey
- 3 Palliative Medicine, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - George Jelinek
- 5 Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Heather Lane
- 7 Rockingham General Hospital, Rockingham, WA, Australia
| | - Claudia Marck
- 5 Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Jennifer Weil
- 3 Palliative Medicine, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
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