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Numata K, Fujitani S, Funakoshi H, Yoshida M, Nomura Y, Tanii R, Takemura N, Bowman J, Lakin JR, Higuchi M, Liu SW, Kennedy M, Tulsky JA, Neville TH, Ouchi K. Differences in code status practice patterns among emergency clinicians working in Japan and the United States. PATIENT EDUCATION AND COUNSELING 2024; 128:108368. [PMID: 39018781 DOI: 10.1016/j.pec.2024.108368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/30/2024] [Accepted: 06/27/2024] [Indexed: 07/19/2024]
Abstract
OBJECTIVE This study aimed to examine self-reported code-status practice patterns among emergency clinicians from Japan and the U.S. METHODS A cross-sectional questionnaire was distributed to emergency clinicians from one academic medical center and four general hospitals in Japan and two academic medical centers in the U.S. The questionnaire was based on a hypothetical case involving a critically ill patient with end-stage lung cancer. The questionnaire items assessed whether respondent clinicians would be likely to pose questions to patients about their preferences for medical procedures and their values and goals. RESULTS A total of 176 emergency clinicians from Japan and the U.S participated. After adjusting for participants' backgrounds, emergency clinicians in Japan were less likely to pose procedure-based questions than those in the U.S. Conversely, emergency clinicians in Japan showed a statistically higher likelihood of asking 10 out of 12 value-based questions. CONCLUSION Significant differences were found between emergency clinicians in Japan and the U.S. in their reported practices on posing procedure-based and patient value-based questions. PRACTICE IMPLICATIONS Serious illness communication training based in the U.S. must be adapted to the Japanese context, considering the cultural characteristics and practical responsibilities of Japanese emergency clinicians.
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Affiliation(s)
- Kenji Numata
- Department of Emergency and Critical Care Medicine, St. Marianna University, 2-16-1 Sugao, Miyamae-ku, Kawasaki City, Kanagawa, Japan; Department of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, USA.
| | - Shigeki Fujitani
- Department of Emergency and Critical Care Medicine, St. Marianna University, 2-16-1 Sugao, Miyamae-ku, Kawasaki City, Kanagawa, Japan; Department of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, USA
| | - Hiraku Funakoshi
- Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu City, Chiba, Japan; Department of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, USA
| | - Minoru Yoshida
- Department of Critical Care Medicine, Yokosuka General Hospital Uwamachi, 2-36, Uwamachi, Yokosuka City, Kanagawa, Japan; Department of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, USA
| | - Yu Nomura
- Department of Emergency Medicine, Kawasaki Municipal Tama Hospital, 1-30-37, Syukugawara, Tama-ku, Kawasaki City, Kanagawa, Japan; Department of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, USA
| | - Rimi Tanii
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Yokohama City Seibu Hospital, 1197-1 Yasashicho, Asahi-ku, Yokohama City, Kanagawa, Japan; Department of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, USA
| | - Narihide Takemura
- Department of Emergency Medicine, Nerima Hikarigaoka Hospital, 2-5-1, Hikarigaoka, Nerima-ku, Tokyo, Japan; Department of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, USA
| | - Jason Bowman
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, USA; Department of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, USA
| | - Joshua R Lakin
- Harvard Medical School, 25 Shattuck St, Boston, MA, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, USA; Department of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, USA; Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, USA
| | - Masaya Higuchi
- Department of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, USA
| | - Shan W Liu
- Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, USA; Department of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, USA
| | - Maura Kennedy
- Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, USA; Department of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, USA
| | - James A Tulsky
- Harvard Medical School, 25 Shattuck St, Boston, MA, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, USA; Department of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, USA; Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, USA
| | - Thanh H Neville
- Department of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, University of California, Los Angeles, CA, USA
| | - Kei Ouchi
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, USA; Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, USA; Department of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, USA
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Aluce LM, Cooper JJ, Emlet LL, Cohen ER, Ostrowski SJ, Wood GJ, Vermylen JH. Bringing competency-based communication training to scale: A multi-institutional virtual simulation-based mastery learning curriculum for Emergency Medicine residents. MEDICAL TEACHER 2024:1-8. [PMID: 38803304 DOI: 10.1080/0142159x.2024.2345267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 04/16/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE Serious illness communication skills are essential for physicians, yet competency-based training is lacking. We address scalability barriers to competency-based communication skills training by assessing the feasibility of a multi-center, virtual simulation-based mastery learning (vSBML) curriculum on breaking bad news (BBN). METHODS First-year emergency medicine residents at three academic medical centers participated in the virtual curriculum. Participants completed a pretest with a standardized patient (SP), a workshop with didactics and small group roleplay with SPs, a posttest with an SP, and additional deliberate practice sessions if needed to achieve the minimum passing standard (MPS). Participants were assessed using a previously published BBN assessment tool that included a checklist and scaled items. Authors compared pre- and posttests to evaluate the impact of the curriculum. RESULTS Twenty-eight (90%) of 31 eligible residents completed the curriculum. Eighty-nine percent of participants did not meet the MPS at pretest. Post-intervention, there was a statistically significant improvement in checklist performance (Median= 93% vs. 53%, p < 0.001) and on all scaled items assessing quality of communication. All participants ultimately achieved the MPS. CONCLUSIONS A multi-site vSBML curriculum brought all participants to mastery in the core communication skill of BBN and represents a feasible, scalable model to incorporate competency-based communication skills education in a widespread manner.
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Affiliation(s)
- Laurie M Aluce
- Instructor of Medicine and Emergency Medicine, Department of Medicine and Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Julie J Cooper
- Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
- Academic Faculty, Department of Emergency Medicine, ChristianaCare, Newark, DE, USA
| | - Lillian Liang Emlet
- Department of Critical Care Medicine and Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Elaine R Cohen
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Simon J Ostrowski
- Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Gordon J Wood
- Department of Medicine and Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Julia H Vermylen
- Department of Medicine and Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Uemura T, Ito K, Yuasa M, Shiozawa Y, Ishikawa H, Nakagawa S, Onishi E, Ouchi K. Enduring Positive Impact of a Virtual Communication Skills Workshop of VitalTalk Pedagogy in a Non-U.S. Setting. Am J Hosp Palliat Care 2024; 41:424-430. [PMID: 37216960 PMCID: PMC11267240 DOI: 10.1177/10499091231177863] [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: 05/24/2023] Open
Abstract
CONTEXT While in-person workshops on serious illness communication skills using VitalTalk pedagogy have been shown to have a long-lasting impact, whether changing the format into virtual would maintain its enduring impact is unknown. Objectives. To examine long-term impacts of a virtual VitalTalk communication workshop. METHODS Physicians in Japan who participated in our virtual VitalTalk workshop were asked to complete a self-assessment survey at 3 time points: before, immediately after, and 2 months after the workshop. We examined self-reported preparedness in 11 communication skills on a 5-point Likert scale at 3 time points, as well as self-reported frequency of practice on 5 communication skills at the pre- and 2-month time points. RESULTS Between January 2021 and June 2022, 117 physicians from 73 institutions across Japan completed our workshop. Seventy-four participants returned the survey at all the 3 time points. Their skill preparedness significantly improved upon the completion of the workshop in all 11 skills (P < .001 for all items). The improvement remained at the same level at 2 months in 7 skills. In 4 of the 11 skills, there was further improvement at the 2-month point. The frequency of self-directed skill practice also increased significantly in the 2-month survey for all 5 skills. CONCLUSION A virtual workshop of VitalTalk pedagogy improved self-reported preparedness of communication skills, and the impact was long-lasting in a non-U.S. setting as it likely induced self-practice of skills. Our findings encourage the use of a virtual format in any geographical location considering its enduring impact and easy accessibility.
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Affiliation(s)
- Takeshi Uemura
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kaori Ito
- Department of Emergency Medicine, Division of Acute Care Surgery, School of Medicine, Teikyo University, Itabashi-ku, Japan
| | - Misuzu Yuasa
- Hospice Division, Seirei Mikatahara General Hospital, Tsu, Japan
| | | | - Hirono Ishikawa
- Teikyo University Graduate School of Public Health, Itabashi-ku, Japan
| | - Shunichi Nakagawa
- Adult Palliative Care Services, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Eriko Onishi
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Kei Ouchi
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
- Serious Illness Care Program, Ariadne Labs, Boston, MA, USA
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Adeyemi O, Ginsburg AD, Kaur R, Cuthel AM, Zhao N, Siman N, Goldfeld KS, Emlet LL, DiMaggio C, Yamarik RL, Bouillon-Minois JB, Chodosh J, Grudzen CR. Serious illness communication skills training for emergency physicians and advanced practice providers: a multi-method assessment of the reach and effectiveness of the intervention. BMC Palliat Care 2024; 23:48. [PMID: 38378532 PMCID: PMC10880358 DOI: 10.1186/s12904-024-01349-y] [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: 02/07/2023] [Accepted: 01/08/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND EM Talk is a communication skills training program designed to improve emergency providers' serious illness conversational skills. Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, this study aims to assess the reach of EM Talk and its effectiveness. METHODS EM Talk consisted of one 4-h training session during which professional actors used role-plays and active learning to train providers to deliver serious/bad news, express empathy, explore patients' goals, and formulate care plans. After the training, emergency providers filled out an optional post-intervention survey, which included course reflections. Using a multi-method analytical approach, we analyzed the reach of the intervention quantitatively and the effectiveness of the intervention qualitatively using conceptual content analysis of open-ended responses. RESULTS A total of 879 out of 1,029 (85%) EM providers across 33 emergency departments completed the EM Talk training, with the training rate ranging from 63 to 100%. From the 326 reflections, we identified meaning units across the thematic domains of improved knowledge, attitude, and practice. The main subthemes across the three domains were the acquisition of Serious Illness (SI) communication skills, improved attitude toward engaging qualifying patients in SI conversations, and commitment to using these learned skills in clinical practice. CONCLUSION Our study showed the extensive reach and the effectiveness of the EM Talk training in improving SI conversation. EM Talk, therefore, can potentially improve emergency providers' knowledge, attitude, and practice of SI communication skills. TRIAL REGISTRATION Clinicaltrials.gov: NCT03424109; Registered on January 30, 2018.
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Affiliation(s)
- Oluwaseun Adeyemi
- Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, 227 East 30thStreet, New York, NY, 10016, USA
| | | | | | - Allison M Cuthel
- Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, 227 East 30thStreet, New York, NY, 10016, USA.
| | - Nicole Zhao
- Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, 227 East 30thStreet, New York, NY, 10016, USA
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Nina Siman
- Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, 227 East 30thStreet, New York, NY, 10016, USA
| | - Keith S Goldfeld
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Lillian Liang Emlet
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Charles DiMaggio
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
- Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | | | | | - Joshua Chodosh
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
- Veteran's Affair, New York Harbor Healthcare System, New York, NY, USA
| | - Corita R Grudzen
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Doyle AJ, Sullivan C, O'Toole M, Tjin A, Simiceva A, Collins N, Murphy P, Anderson MJ, Mulhall C, Condron C, Nestel D, MacAulay R, McNaughton N, Coffey F, Eppich W. Training simulated participants for role portrayal and feedback practices in communication skills training: A BEME scoping review: BEME Guide No. 86. MEDICAL TEACHER 2024; 46:162-178. [PMID: 37552799 DOI: 10.1080/0142159x.2023.2241621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
BACKGROUND Providing feedback is a key aspect of simulated participants' (SPs) educational work. In teaching contexts, the ability to provide feedback to learners is central to their role. Suboptimal feedback practices may deny learners the valuable feedback they need to learn and improve. This scoping review systematically maps the evidence related to SPs' role as educators and identifies how SPs prepare for their role and feedback practices. METHODS The authors conducted a scoping review and included a group of international stakeholders with experience and expertise in SP methodology. Five online databases were systematically searched and ERIC, MedEdPortal and MedEdPublish were hand searched to identify relevant studies. Inclusion/exclusion criteria were developed. Data screening and subsequently data charting were performed in pairs. The results of data charting were thematically analysed including categories relating to the Association of SP Educators (ASPE) Standards of Best Practice (SOBP). RESULTS From 8179 articles identified for the title and abstract screening, 98 studies were included. Studies reported the benefit of SPs' authentic role portrayal and feedback interactions for learners and on the reported learning outcomes. Data was heterogeneous with a notable lack of consistency in the detail regarding the scenario formats for communication skills training interventions, SP characteristics, and approaches to training for feedback and role portrayal. CONCLUSIONS The published literature has considerable heterogeneity in reporting how SPs are prepared for role portrayal and feedback interactions. Additionally, our work has identified gaps in the implementation of the ASPE SOBP, which promotes effective SP-learner feedback interactions. Further research is required to identify effective applications of SP methodology to prepare SPs for their role as educators.
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Affiliation(s)
- Andrea J Doyle
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Clare Sullivan
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Michelle O'Toole
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Anna Tjin
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Anastasija Simiceva
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Naoise Collins
- Department of Visual & Human Centred Computing, Dundalk Institute of Technology, Co. Louth
| | - Paul Murphy
- RCSI Library, RCSI University of Medicine and Health Sciences, Dublin Ireland
| | - Michael J Anderson
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Claire Mulhall
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Claire Condron
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Debra Nestel
- School of Clinical Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, Australia
- Department of Surgery, University of Melbourne, Australia
| | - Robert MacAulay
- School of Medicine, University of California San Diego, United States of America
| | - Nancy McNaughton
- The Wilson Centre for Research in Education, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Frank Coffey
- DREEAM (Department of Research and Education in Emergency and Acute medicine, Nottingham University Hospitals' NHS Trust)
- School of Health Sciences, University of Nottingham, UK
| | - Walter Eppich
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Yusufov M, Adeyemi O, Flannery M, Bouillon-Minois JB, Van Allen K, Cuthel AM, Goldfeld KS, Ouchi K, Grudzen CR. Psychometric Properties of the Functional Assessment of Cancer Therapy-General for Evaluating Quality of Life in Patients With Life-Limiting Illness in the Emergency Department. J Palliat Med 2024; 27:63-74. [PMID: 37672598 PMCID: PMC11074445 DOI: 10.1089/jpm.2022.0270] [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] [Accepted: 07/20/2023] [Indexed: 09/08/2023] Open
Abstract
Background: The Functional Assessment of Cancer Therapy-General (FACT-G) is a widely used quality-of-life measure. However, no studies have examined the FACT-G among patients with life-limiting illnesses who present to emergency departments (EDs). Objective: The goal of this study was to examine the psychometric properties of the FACT-G among patients with life-limiting illnesses who present to EDs in the United States. Methods: This cross-sectional study pooled data from 12 EDs between April 2018 and January 2020 (n = 453). Patients enrolled in the study were adults with one or more of the four life-limiting illnesses: advanced cancer, Congestive Heart Failure, Chronic Obstructive Pulmonary Disease, or End-Stage Renal Disease. We conducted item, exploratory, and confirmatory analyses (exploratory factor analysis [EFA] and confirmatory factor analysis [CFA]) to determine the psychometric properties of the FACT-G. Results: The FACT-G had good internal consistency (Cronbach's alpha α = 0.88). The simplest EFA model was a six-factor structure. The CFA supported the six-factor structure, evidenced by the adequate fit indices (comparative fit index = 0.93, Tucker-Lewis index = 0.92, root-mean-square error of approximation = 0.05; 90% confidence interval: 0.04 - 0.06). The six-factor structure comprised the physical, emotional, work and daily activities-related functional well-being, and the family and friends-related social well-being domains. Conclusions: The FACT-G is a reliable measure of health-related quality of life among patients with life-limiting illnesses who present to the ED. Clinical Trial Registration: NCT03325985.
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Affiliation(s)
- Miryam Yusufov
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Oluwaseun Adeyemi
- Ronald O. Perelman Department of Emergency Medicine, Division of Supportive and Acute Care Services, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Mara Flannery
- Ronald O. Perelman Department of Emergency Medicine, Division of Supportive and Acute Care Services, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Kaitlyn Van Allen
- Ronald O. Perelman Department of Emergency Medicine, Division of Supportive and Acute Care Services, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Allison M. Cuthel
- Ronald O. Perelman Department of Emergency Medicine, Division of Supportive and Acute Care Services, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Keith S. Goldfeld
- Department of Population Health, Division of Supportive and Acute Care Services, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kei Ouchi
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Serious Illness Care Program, Ariadne Labs, Boston, Massachusetts, USA
| | - Corita R. Grudzen
- Ronald O. Perelman Department of Emergency Medicine, Division of Supportive and Acute Care Services, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Population Health, Division of Supportive and Acute Care Services, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Pilnick A, O'Brien R, Beeke S, Goldberg S, Murray M, Harwood RH. Conversation Analysis Based Simulation (CABS): A method for improving communication skills training for healthcare practitioners. Health Expect 2023; 26:2461-2474. [PMID: 37589441 PMCID: PMC10632656 DOI: 10.1111/hex.13834] [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] [Received: 04/28/2023] [Revised: 07/06/2023] [Accepted: 07/18/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Actors portraying simulated patients are widely used in communication skills training in healthcare, but debates persist over the authenticity of these interactions. However, healthcare professionals value simulation-based training because of the opportunity to think and react in real time, which alternatives cannot provide. OBJECTIVE To describe a method for the use of simulation which maximises authenticity by grounding training in real, observed, patterns of patient communication. DESIGN Naturally occurring care interactions were video recorded and analysed using conversation analysis (CA) to identify communication patterns. We focused on sites of recurring interactional trouble as areas for training, and identified more and less effective ways of dealing with these. We used the CA findings to train actors portraying simulated patients, based on the observed interactional patterns. SETTINGS AND PARTICIPANTS Patients living with dementia and healthcare practitioners (HCPs) on two acute healthcare of the elderly wards in the English East Midlands. OUTCOME MEASURES One month later HCPs reported using the skills learned in clinical practice. Masked-ratings of before and after simulated patient encounters confirmed these self-reports in relation to one key area of training. RESULTS The Conversation Analysis Based Simulation (CABS) method used in this setting showed positive results across a range of quantitative and qualitative outcome measures. What is significant for the transferability of the method is that qualitative feedback from trainees highlighted the ability of the method to not only illuminate their existing effective practices, but to understand why these were effective and be able to articulate them to others. DISCUSSION/CONCLUSION While the CABS method was piloted in the dementia care setting described here, it has potential applicability across healthcare settings where simulated consultations are used in communication skills training. Grounding simulated interaction in the observed communication patterns of real patients is an important means of maximising authenticity. PATIENT AND PUBLIC CONTRIBUTION The VideOing to Improve dementia Communication Education (VOICE) intervention which piloted the CABS method was developed by a multidisciplinary team, including three carers of people with dementia. People living with dementia were involved in the rating of the before and after video simulation assessments.
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Affiliation(s)
- Alison Pilnick
- School of Sociology and Social Policy, University of NottinghamNottinghamUK
| | - Rebecca O'Brien
- School of Health Sciences, University of NottinghamUK and Nottinghamshire Healthcare NHS Foundation TrustNottinghamshireUK
| | - Suzanne Beeke
- Division of Psychology and Language SciencesUniversity College LondonLondonUK
| | - Sarah Goldberg
- School of Health SciencesUniversity of NottinghamNottinghamUK
| | | | - Rowan H. Harwood
- School of Health Sciences, University of NottinghamUK and Nottingham University Hospitals NHS TrustNottinghamUK
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Ouchi K, George N, Bowman J, Block SD. Empower Emergency Physicians to Make Patient-Centered Recommendations Regarding Code Status With Serious Illness Communication Training-Resident-Desired, Standard of Emergency Care in 2023. Ann Emerg Med 2023; 82:594-597. [PMID: 37462599 PMCID: PMC11267587 DOI: 10.1016/j.annemergmed.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/30/2022] [Accepted: 06/01/2023] [Indexed: 10/23/2023]
Affiliation(s)
- Kei Ouchi
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA; Department of Emergency Medicine, Harvard Medical School, Boston, MA; Serious Illness Care Program, Ariadne Labs, Boston, MA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA.
| | - Naomi George
- Department of Emergency Medicine, University of New Mexico Health Science Center, Albuquerque, NM
| | - Jason Bowman
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA; Department of Emergency Medicine, Harvard Medical School, Boston, MA; Serious Illness Care Program, Ariadne Labs, Boston, MA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
| | - Susan D Block
- Serious Illness Care Program, Ariadne Labs, Boston, MA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA; Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
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9
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Adeyemi OJ, Siman N, Goldfeld KS, Cuthel AM, Bouillon-Minois JB, Grudzen CR. Emergency Providers' Knowledge and Attitudes Toward Hospice and Palliative Care: A Cross-Sectional Analysis Across 35 Emergency Departments in the United States. J Palliat Med 2023; 26:1252-1260. [PMID: 37262130 PMCID: PMC10623080 DOI: 10.1089/jpm.2022.0545] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 06/03/2023] Open
Abstract
Background: Emergency providers' knowledge and attitudes may be a barrier to adopting hospice and palliative care practice. Objective: To assess provider characteristics associated with knowledge and attitudes toward hospice and palliative care (KAHP). Design: Cross-sectional analysis. Setting/Subjects: Emergency physicians, advanced practice providers (APPs), and nurses from 35 U.S. emergency departments (EDs) enrolled in a provider-focused intervention. Measurement: The outcome measures were the total and subscale scores of the KAHP scale. The predictor variables were age, sex, race/ethnicity, and years of practice. We reported the observed association using a linear mixed-effects regression model. Results: The mean KAHP score, rated from 10 to 50, was 36. Increased years of practice were associated with increased mean self-reported knowledge and attitudes scores among APPs and nurses. Conclusion: Understanding the provider characteristics associated with hospice and palliative care adoption in the ED may inform the development of interventions for specific providers. ClinicalTrials.gov (NCT03424109).
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Affiliation(s)
- Oluwaseun John Adeyemi
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Nina Siman
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Keith S. Goldfeld
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Allison M. Cuthel
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Jean-Baptiste Bouillon-Minois
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Emergency Medicine, F-63000 Clermont-Ferrand, France
| | - Corita R. Grudzen
- Division of Supportive and Acute Care Services, Department of Medicine; Fern Grayer Chair in Oncology and Patient Experience, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Stanich J, Sunga K, Loprinzi-Brauer C, Ginsburg A, Ingram C, Bellolio F, Cabrera D. Teaching Palliative Care to Emergency Medicine Residents Using Gamified Deliberate Practice-Based Simulation: Palliative Gaming Simulation Study. JMIR MEDICAL EDUCATION 2023; 9:e43710. [PMID: 37585258 PMCID: PMC10468704 DOI: 10.2196/43710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 03/07/2023] [Accepted: 05/09/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND Emergency departments (EDs) care for many patients nearing the end of life with advanced serious illnesses. Simulation training offers an opportunity to teach physicians the interpersonal skills required to manage end-of-life care. OBJECTIVE We hypothesized a gaming simulation of an imminently dying patient using the LIVE. DIE. REPEAT (LDR) format, would be perceived as an effective method to teach end-of-life communication and palliative care management skills. METHODS This was a gaming simulation replicating the experience of caring for a dying patient with advanced serious illness in the ED. The scenario involved a patient with pancreatic cancer presenting with sepsis and respiratory distress, with a previously established goal of comfort care. The gaming simulation game was divided into 4 stages, and at each level, learners were tasked with completing 1 critical action. The gaming simulation was designed using the LDR serious game scheme in which learners are allowed infinite opportunities to progress through defined stages depicting a single patient scenario. If learners successfully complete the predetermined critical actions of each stage, the game is paused, and there is a debriefing to reinforce knowledge or skills before progressing to the next stage of the gaming simulation. Conversely, if learners do not achieve the critical actions, the game is over, and learners undergo debriefing before repeating the failed stage with an immediate transition into the next. We used the Simulation Effectiveness Tool-Modified survey to evaluate perceived effectiveness in teaching end-of-life management. RESULTS Eighty percent (16/20) of residents completed the Simulation Effectiveness Tool-Modified survey, and nearly 100% (20/20) either strongly or somewhat agreed that the gaming simulation improved their skills and confidence at the end of life in the following dimensions: (1) better prepared to respond to changes in condition, (2) more confident in assessment skills, (3) teaching patients, (4) reporting to the health care team, (5) empowered to make clinical decisions, and (6) able to prioritize care and interventions. All residents felt the debriefing contributed to learning and provided opportunities to self-reflect. All strongly or somewhat agree that they felt better prepared to respond to changes in the patient's condition, had a better understanding of pathophysiology, were more confident on their assessment skills, and had a better understanding of the medications and therapies after the gaming simulation. A total of 88% (14/16) of them feel more empowered to make clinical decisions. After completing the gaming simulation, 88% (14/16) of residents strongly agreed that they would feel more confident communicating with a patient and prioritizing care interventions in this context. CONCLUSIONS This palliative gaming simulation using the LDR format was perceived by resident physicians to improve confidence in end-of-life communication and palliative care management.
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Affiliation(s)
- Jessica Stanich
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, United States
| | - Kharmene Sunga
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, United States
| | | | - Alexander Ginsburg
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, United States
| | - Cory Ingram
- Division of Palliative, Department of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Fernanda Bellolio
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, United States
- Department of Health Science Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, United States
| | - Daniel Cabrera
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, United States
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11
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Ginsburg AD, Arnold RM, Silverman EJ. Increasing Our Footprint: Palliative Care in the Emergency Department. J Palliat Med 2023; 26:604-605. [PMID: 37130282 DOI: 10.1089/jpm.2023.0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Affiliation(s)
- Alexander D Ginsburg
- Section of Palliative Care, Division of Community Internal Medicine, Geriatrics, and Palliative Care, Departments of Emergency Medicine, and Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Robert M Arnold
- Palliative Research Center, Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ethan J Silverman
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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12
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Breyre AM, Wang DH, Brooten JK, Colwell CB, Hanson KC, Taigman M, Lyng JW. EMS Care of Adult Hospice Patients- a Position Statement and Resource Document of NAEMSP and AAHPM. PREHOSP EMERG CARE 2023; 27:560-565. [PMID: 36961936 DOI: 10.1080/10903127.2023.2193978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/08/2023] [Accepted: 03/13/2023] [Indexed: 03/26/2023]
Abstract
Emergency medical services (EMS) systems are designed to provide care in the field and while transporting patients to a hospital; however, patients enrolled in hospice may not want invasive therapies nor benefit from hospitalization. For many reasons, encounters with hospice patients can be challenging for EMS systems, EMS clinicians, hospice clinicians, hospice patients, and their families.
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Affiliation(s)
- Amelia M Breyre
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - David H Wang
- Department of Palliative Medicine, Scripps Health, San Diego, California
| | - Justin K Brooten
- Department of Emergency Medicine & Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Christopher B Colwell
- Department of Emergency Medicine, University of California San Francisco Zuckerburg San Francisco General Hospital, San Francisco, California
| | - Kenneth C Hanson
- Department of Emergency Medicine, Central Michigan University College of Medicine-East Campus, Saginaw, Michigan
| | | | - John W Lyng
- Department of Emergency Medicine, University of Minnesota, Minneapolis, Minnesota
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13
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Adeyemi OJ, Bouillon-Minois JB, Siman N, Cuthel AM, Goldfeld KS, Grudzen CR. Knowledge and Attitudes Toward Hospice and Palliative Care: Instrument Validation Among Emergency Providers. Am J Hosp Palliat Care 2023; 40:280-290. [PMID: 35549544 DOI: 10.1177/10499091221098664] [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: 11/16/2022] Open
Abstract
Background: Emergency providers can engage in goals of care discussions and hospice and palliative care referrals. Little is known about their knowledge and attitudes, which may influence these care practices. Objective: This study aims to re-validate the knowledge and attitude towards hospice and palliative care (KAHP) scale and assess the scale's latent constructs among emergency providers. Methods: The scale consists of ten items measured on a five-point Likert scale. Five of the ten items were reverse scored. Content validation was performed by ten experts in Hospice and Palliative Medicine and Emergency Medicine. Baseline surveys of emergency physicians, advance practice providers, and nurses conducted in the context of a pragmatic, randomized control trial were used for the item analysis and the exploratory and confirmatory factor analyses. Results: The KAHP scale is a ten-item scale scored from 10 to 50. Based on the synthesis of content validation results and the item analysis, all ten items were retained. The item and scale Content Validity Index were each .91. The reliability of the scale was .64 and the exploratory factor analysis identified three underlying constructs defined as self-rated knowledge, support for hospice and palliative care practice, and views on provider-patient communication. The presence of good model fit indices supported the structural integrity of the constructs. Conclusion: We present a validated instrument that is suitable for assessing knowledge and attitude variations toward interventions designed to improve hospice and palliative care practice among emergency providers.
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Affiliation(s)
- Oluwaseun J Adeyemi
- Ronald O. Perelman Department of Emergency Medicine, 12296New York University Grossman School of Medicine, New York, NY, USA
| | - Jean-Baptiste Bouillon-Minois
- Ronald O. Perelman Department of Emergency Medicine, 12296New York University Grossman School of Medicine, New York, NY, USA
- Emergency Department55174, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Nina Siman
- Ronald O. Perelman Department of Emergency Medicine, 12296New York University Grossman School of Medicine, New York, NY, USA
| | - Allison M Cuthel
- Ronald O. Perelman Department of Emergency Medicine, 12296New York University Grossman School of Medicine, New York, NY, USA
| | - Keith S Goldfeld
- Ronald O. Perelman Department of Emergency Medicine, 12296New York University Grossman School of Medicine, New York, NY, USA
- Department of Population Health, 12296New York University Grossman School of Medicine, New York, NY, USA
| | - Corita R Grudzen
- Ronald O. Perelman Department of Emergency Medicine, 12296New York University Grossman School of Medicine, New York, NY, USA
- Department of Population Health, 12296New York University Grossman School of Medicine, New York, NY, USA
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14
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Adeyemi O, Ginsburg AD, Kaur R, Cuthel A, Zhao N, Siman N, Goldfeld K, Emlet LL, DiMaggio C, Yamarik R, Bouillon-Minois JB, Chodosh J, Grudzen CR. Serious Illness Communication Skills Training for Emergency Physicians and Advanced Practice Providers: A Multi-Method Assessment of the Reach and Effectiveness of the Intervention. RESEARCH SQUARE 2023:rs.3.rs-2561749. [PMID: 36865121 PMCID: PMC9980220 DOI: 10.21203/rs.3.rs-2561749/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Background EM Talk is a communication skills training program designed to improve emergency providers' serious illness conversational skills. Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, this study aims to assess the reach of EM Talk and its effectiveness. Methods EM Talk is one of the components of Primary Palliative Care for Emergency Medicine (EM) intervention. It consisted of one 4-hour training session during which professional actors used role-plays and active learning to train providers to deliver serious/bad news, express empathy, explore patients' goals, and formulate care plans. After the training, emergency providers filled out an optional post-intervention survey, which included course reflections. Using a multi-method analytical approach, we analyzed the reach of the intervention quantitatively and the effectiveness of the intervention qualitatively using conceptual content analysis of open-ended responses. Results A total of 879 out of 1,029 (85%) EM providers across 33 emergency departments completed the EM Talk training, with the training rate ranging from 63-100%. From the 326 reflections, we identified meaning units across the thematic domains of improved knowledge, attitude, and practice. The main subthemes across the three domains were the acquisition of discussion tips and tricks, improved attitude toward engaging qualifying patients in serious illness (SI) conversations, and commitment to using these learned skills in clinical practice. Conclusion Effectively engaging qualifying patients in serious illness conversations requires appropriate communication skills. EM Talk has the potential to improve emergency providers' knowledge, attitude, and practice of SI communication skills. Trial registration NCT03424109.
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15
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Conceição Gomes Lourenço MD, Fernandes CS, Campos Vale MBR. The use of games by nurses in palliative care: a scoping review. Int J Palliat Nurs 2023; 29:58-65. [PMID: 36822613 DOI: 10.12968/ijpn.2023.29.2.58] [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: 02/25/2023]
Abstract
Background: Nursing is at the forefront of palliative care. Games are an innovative strategy in palliative care training. Aims: This study aimed to examine the usefulness of games for nurses in palliative care. Methods: A scoping review was conducted using the following databases: CINAHL and PUBMED (which includes MEDLINE, PsycINFO, SCOPUS and SciELO). The steps outlined by the Joanna Briggs Institute were followed. Findings: Of the 685 articles initially identified, 17 were included for analysis. Games used were role-play (n=12), card games (n=1), digital games (n=1), board games (n=1), reflection games (n=1) and experimental games (n=1). Games were aimed at nurses (n=6) and nursing students (n= 1 1). Game advantages included: improved palliative care knowledge, increased communication skills, reduced negative emotions and increased multidisciplinary team skills. Conclusions: Effective and innovative pedagogical techniques are required training techniques for nurses and nursing students who provide palliative care, as they can reduce negative emotions such as fear, anguish and guilt.
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Affiliation(s)
| | - Carla Sílvia Fernandes
- Associate Professor, Nursing School of Porto; Center for Health Technology and Services Research (CINTESIS), Portugal
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16
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Abstract
OBJECTIVE There has been increasing recognition of the potential of games in health; however, knowledge of their application in palliative care is lacking. Therefore, this study aimed to identify and map the available evidence on the use of games in palliative care, analyzing how research has been conducted on this topic and identifying gaps in knowledge. METHOD A scoping review was carried out. The literature search was conducted using the respective descriptors and search syntax appropriate to each of the databases searched. The review included all study types with no time limits. RESULTS Of the 685 articles initially identified, 53 were included for final analysis. Several different game types were identified, with the majority of studies using role-play (n = 29) and card games (n = 17). The games analyzed were essentially aimed at empowering patients (n = 14), and in some cases, extended to families or caregivers, as well as to medical and nursing students. The analysis of the articles in this review resulted in two major themes: Role-playing for training in palliative care and card games to discuss end-of-life care. SIGNIFICANCE OF RESULTS Games allow space for the expression of emotions and promote creativity. They can be applied both in a training context, to enable health professionals to develop essential skills in palliative care, and for patients, families, and caregivers, allowing them to talk about serious things while playing.
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17
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Prachanukool T, Aaronson EL, Lakin JR, Higuchi M, Lee RS, Santangelo I, Hasdianda MA, Wang W, George N, Liu SW, Kennedy M, Schonberg MA, Block SD, Tulsky JA, Ouchi K. Communication Training and Code Status Conversation Patterns Reported by Emergency Clinicians. J Pain Symptom Manage 2023; 65:58-65. [PMID: 36265695 PMCID: PMC9790029 DOI: 10.1016/j.jpainsymman.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/06/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022]
Abstract
CONTEXT During acute health decompensations for seriously ill patients, emergency clinicians often determine the intensity end-of-life care. Little is known about how emergency clinicians conduct these conversations, especially among those who have received serious illness communication training. OBJECTIVES To determine the self-reported practice patterns of code status conversations by emergency clinicians with and without serious illness communication training. METHODS A cross-sectional survey was conducted among emergency clinicians with and without a recent evidence-based, serious illness communication training tailored for emergency clinicians. Emergency clinicians were included from two academic medical centers. A five-point Likert scale ("very unlikely" to "very likely" to ask) was used to assess the self-reported likelihood of asking about patients' preferences for medical procedures and patients' values and goals. RESULTS Among 161 respondents (71% response rate), 77 (48%) received the training. A total of 70% of emergency clinicians reported asking about procedure-based questions, and only 38% reported asking about patient's values regarding end-of-life care. For value-based questions, statistically significant differences were observed between emergency clinicians who underwent the training and those who did not in four of the seven questions asked (e.g., the higher odds of exploring the patient's life priorities [adjusted OR = 4.34, 95% CI = 1.95-9.65, P-value < 0.001]). No difference was observed in the self-reported rates of all procedure-based questions between the two groups. CONCLUSION Most emergency clinicians reported asking about procedure-based questions, and some asked about patient's value-based questions. Clinicians with recent serious illness communication training may ask more about some values and priorities.
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Affiliation(s)
- Thidathit Prachanukool
- Department of Emergency Medicine (T.P., R.S.L., M.A.H., K.O.), Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School (T.P., E.L.A., J.R.L., M.A.H., S.W.L., M.K., M.A.S., S.D.B., J.A.T., K.O.), Boston, Massachusetts, USA; Department of Emergency Medicine (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Emily L Aaronson
- Harvard Medical School (T.P., E.L.A., J.R.L., M.A.H., S.W.L., M.K., M.A.S., S.D.B., J.A.T., K.O.), Boston, Massachusetts, USA; Department of Emergency Medicine (E.L.A., I.S., S.W.L., M.K.), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joshua R Lakin
- Harvard Medical School (T.P., E.L.A., J.R.L., M.A.H., S.W.L., M.K., M.A.S., S.D.B., J.A.T., K.O.), Boston, Massachusetts, USA; Serious Illness Care Program (J.R.L., K.O.), Ariadne Labs, Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care (J.R.L., S.D.B., J.A.T., K.O.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Masaya Higuchi
- Palliative Care and Geriatric Medicine (M.H.), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rachel S Lee
- Department of Emergency Medicine (T.P., R.S.L., M.A.H., K.O.), Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ilianna Santangelo
- Department of Emergency Medicine (E.L.A., I.S., S.W.L., M.K.), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mohammad A Hasdianda
- Department of Emergency Medicine (T.P., R.S.L., M.A.H., K.O.), Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School (T.P., E.L.A., J.R.L., M.A.H., S.W.L., M.K., M.A.S., S.D.B., J.A.T., K.O.), Boston, Massachusetts, USA
| | - Wei Wang
- Department of Medicine and Neurology, Brigham and Women's Hospital (W.W.), Boston, Massachusetts, USA
| | - Naomi George
- Department of Emergency Medicine `(N.G.), Division of Critical Care, University of New Mexico, Albuquerque, New Mexico, USA
| | - Shan W Liu
- Harvard Medical School (T.P., E.L.A., J.R.L., M.A.H., S.W.L., M.K., M.A.S., S.D.B., J.A.T., K.O.), Boston, Massachusetts, USA; Department of Emergency Medicine (E.L.A., I.S., S.W.L., M.K.), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Maura Kennedy
- Harvard Medical School (T.P., E.L.A., J.R.L., M.A.H., S.W.L., M.K., M.A.S., S.D.B., J.A.T., K.O.), Boston, Massachusetts, USA; Department of Emergency Medicine (E.L.A., I.S., S.W.L., M.K.), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mara A Schonberg
- Harvard Medical School (T.P., E.L.A., J.R.L., M.A.H., S.W.L., M.K., M.A.S., S.D.B., J.A.T., K.O.), Boston, Massachusetts, USA; Department of Medicine (M.A.S.), Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Susan D Block
- Harvard Medical School (T.P., E.L.A., J.R.L., M.A.H., S.W.L., M.K., M.A.S., S.D.B., J.A.T., K.O.), Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care (J.R.L., S.D.B., J.A.T., K.O.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Departments of Medicine (S.D.B., J.A.T.), Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - James A Tulsky
- Harvard Medical School (T.P., E.L.A., J.R.L., M.A.H., S.W.L., M.K., M.A.S., S.D.B., J.A.T., K.O.), Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care (J.R.L., S.D.B., J.A.T., K.O.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Departments of Medicine (S.D.B., J.A.T.), Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kei Ouchi
- Department of Emergency Medicine (T.P., R.S.L., M.A.H., K.O.), Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School (T.P., E.L.A., J.R.L., M.A.H., S.W.L., M.K., M.A.S., S.D.B., J.A.T., K.O.), Boston, Massachusetts, USA; Serious Illness Care Program (J.R.L., K.O.), Ariadne Labs, Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care (J.R.L., S.D.B., J.A.T., K.O.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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Ito K, George N, Wilson J, Bowman J, Aaronson E, Ouchi K. Primary palliative care recommendations for critical care clinicians. J Intensive Care 2022; 10:20. [PMID: 35428371 PMCID: PMC9013119 DOI: 10.1186/s40560-022-00612-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 04/06/2022] [Indexed: 11/19/2022] Open
Abstract
Palliative care is an interdisciplinary care to optimize physical, psychosocial, and spiritual symptoms of patients and their families whose quality of life is impaired by serious, life-limiting illness. In 2021, the importance of providing palliative care in the intensive care unit (ICU) is well recognized by various studies to alleviate physical symptoms due to invasive treatments, to set patient-centered goals of care, and to provide end-of-life care. This paper summarizes the evidence known to date on primary palliative care delivered in the ICU settings. We will then discuss the potential benefits and harms of primary palliative care so that critical care clinicians are better equipped to decide what services might best improve the palliative care needs in their ICUs.
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19
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Owen L, Steel A, Goffe K, Pleming J, Sampson EL. A multidisciplinary simulation programme to improve advance care planning skills and engagement across primary and secondary care. Clin Med (Lond) 2022; 22:51-57. [PMID: 38589101 PMCID: PMC8813010 DOI: 10.7861/clinmed.2021-0240] [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: 11/27/2022]
Abstract
BACKGROUND In the context of an ageing population, many healthcare professionals have limited experience and confidence in having necessary advance care planning (ACP) conversations. METHODS We conducted nine half-day simulation sessions, using professional actors. One-hundred and thirty-two participants attended from multidisciplinary backgrounds across primary and secondary care. RESULTS Following the course, 90.2% felt confident or very confident initiating conversations, compared with 14.4% beforehand. Understanding of when ACP is appropriate also increased from 70% to 100%. Post-course, 98% of participants stated that they would be more likely to initiate an ACP. Three months later, 86% had a sustained change in practice. All participants said they would recommend this simulation course and multidisciplinary approach. CONCLUSION Multidisciplinary simulation training is an effective way to teach ACP to doctors, nurses and allied healthcare professionals. The simulation was shown to improve participant understanding, confidence and reduce barriers to discussions, both immediately and 3 months later.
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Affiliation(s)
| | | | | | - Joanna Pleming
- C, stroke and general internal medicine, Barnet Hospital, London, UK
| | - Elizabeth L Sampson
- Dconsultant liaison psychiatrist, North Middlesex University Hospital, London, UK and clinical professor in dementia and palliative care, University College London, London, UK
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20
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Ito K, Uemura T, Yuasa M, Onishi E, Shiozawa Y, Ishikawa H, Ouchi K, Nakagawa S. The Feasibility of Virtual VitalTalk Workshops in Japanese: Can Faculty Members in the US Effectively Teach Communication Skills Virtually to Learners in Japan? Am J Hosp Palliat Care 2021; 39:785-790. [PMID: 34493061 DOI: 10.1177/10499091211044477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND VitalTalk is an established training program for serious illness conversations in the US. Previously, this training course has been provided in-person in Japanese, but never virtually. OBJECTIVES To evaluate the feasibility of a virtually administered VitalTalk workshop in Japanese. SETTING/SUBJECTS We conducted a virtual workshop which consisted of 2 days (3 hours per day) of synchronous sessions and preceding asynchronous modules. Five VitalTalk faculty members in the US facilitated 4 workshops for 48 physicians from 33 institutions across Japan. Learners completed surveys before and after the workshop. MEASUREMENTS To evaluate the feasibility, learners were asked for their satisfaction with the workshop and the virtual format as primary outcomes and their self-assessed preparedness in serious illness communication as the secondary outcome. Each question employed a 5-point Likert scale. RESULTS All learners (n = 48, male 79%) participated in the survey. The mean score of the learners' satisfaction was 4.69 or higher in all questions. The mean score of the virtual format's satisfaction was 4.33 or higher in all questions. The mean score of self-reported preparedness on the 11 questions were between 2.30 and 3.34 before the workshop, all of which significantly increased to 3.08 through 3.96 after the workshop (p < 0.01 in all questions). CONCLUSION Learners in Japan perceived the virtual format of our VitalTalk workshop as satisfactory, and their self-reported preparedness improved significantly after the workshop. VitalTalk faculty members in the US were able to provide virtual communication training to physicians in Japan.
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Affiliation(s)
- Kaori Ito
- Division of Acute Care Surgery, Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Takeshi Uemura
- Department of Geriatric Medicine, John A. Burns School of Medicine at the University of Hawai'i at Manoa, Honolulu, HI, USA
| | | | - Eriko Onishi
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA
| | | | - Hirono Ishikawa
- Teikyo University Graduate School of Public Health, Tokyo, Japan
| | - Kei Ouchi
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA.,Serious Illness Care Program, Ariadne Labs, Boston, MA, USA.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Shunichi Nakagawa
- Adult Palliative Care Services, Columbia University, New York, NY, USA
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21
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Novaes LMS, Paiva EMDC, O'Mahony A, Garcia ACM. Roleplay as an Educational Strategy in Palliative Care: A Systematic Integrative Review. Am J Hosp Palliat Care 2021; 39:570-580. [PMID: 34350773 DOI: 10.1177/10499091211036703] [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
INTRODUCTION Simulation activities, such as roleplay, have become established in undergraduate and graduate education in several subjects of healthcare. The objective of this study was to synthesize the evidence available in the literature on the use of roleplay as an educational strategy in palliative care. METHODS Using the method proposed by Whittemore and Knafl, this integrative systematic review was carried out based on the following guiding question: "What is the available evidence in the literature on the use of roleplay as an educational strategy in the teaching of palliative care?" The databases used for the selection of articles were the following: Web of Science, Scopus, Cochrane Library, PubMed, CINAHL, EMBASE, and LILACS. There were no limitations regarding the year of publication or language. RESULTS The articles (n = 34) were grouped into 3 categories, according to the purpose of roleplay use: 1) Use of roleplay as an educational strategy to teach communication in palliative care; 2) Use of roleplay as an educational strategy to teach the communication of bad news, and 3) Use of roleplay as an educational strategy to teach end-of-life care. CONCLUSION Roleplay has been employed in the teaching of palliative care in order to develop skills related to communication and to the provision of end-of-life care. These educational activities have mainly been directed to healthcare students and professionals. Future investigations should further evaluate the efficacy of this teaching strategy, based on studies with more robust designs that allow the establishment of cause-and-effect relationships.
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Affiliation(s)
| | | | - Aoife O'Mahony
- School of Psychology, 2112Cardiff University, Cardiff, Wales, United Kingdom
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22
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Loffredo AJ, Chan GK, Wang DH, Goett R, Isaacs ED, Pearl R, Rosenberg M, Aberger K, Lamba S. United States Best Practice Guidelines for Primary Palliative Care in the Emergency Department. Ann Emerg Med 2021; 78:658-669. [PMID: 34353647 DOI: 10.1016/j.annemergmed.2021.05.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 05/15/2021] [Accepted: 05/21/2021] [Indexed: 11/18/2022]
Abstract
The growing palliative care needs of emergency department (ED) patients in the United States have motivated the development of ED primary palliative care principles. An expert panel convened to develop best practice guidelines for ED primary palliative care to help guide frontline ED clinicians based on available evidence and consensus opinion of the panel. Results include recommendations for screening and assessment of palliative care needs, ED management of palliative care needs, goals of care conversations, ED palliative care and hospice consults, and transitions of care.
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Affiliation(s)
- Anthony J Loffredo
- Department of Emergency Medicine, Cedars-Sinai Medical Center, Los Angeles, CA.
| | - Garrett K Chan
- Department of Physiologic Nursing, University of California, San Francisco, CA
| | - David H Wang
- Division of Palliative Medicine, Scripps Health, San Diego, CA
| | - Rebecca Goett
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ
| | - Eric D Isaacs
- Department of Emergency Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA
| | - Rachel Pearl
- Department of Emergency Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Mark Rosenberg
- Department of Emergency Medicine, St Joseph's Health, Paterson and Wayne, NJ
| | - Kate Aberger
- Division of Palliative Medicine and Geriatrics, St Joseph's Health, Paterson, NJ; Department of Emergency Medicine, Robert Wood Johnson University Hospital Somerset, Somerville, NJ
| | - Sangeeta Lamba
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ
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Onishi E, Nakagawa S, Uemura T, Shiozawa Y, Yuasa M, Ito K, Kobayashi Y, Ishikawa H, Ouchi K. Physicians' Perceptions and Suggestions for the Adaptation of a US-Based Serious Illness Communication Training in a Non-US Culture: A Qualitative Study. J Pain Symptom Manage 2021; 62:400-409.e3. [PMID: 33290856 PMCID: PMC8244824 DOI: 10.1016/j.jpainsymman.2020.11.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/26/2020] [Accepted: 11/28/2020] [Indexed: 01/08/2023]
Abstract
CONTEXT US-based serious illness communication training pedagogy has not been well studied outside of the United States. OBJECTIVES To explore the perception of a US-based, serious illness communication training pedagogy in a non-US culture and to identify aspects requiring cultural adaptations. METHODS In September 2019, we conducted a qualitative study using convenient sampling at two urban, academic medical centers in Tokyo, Japan. Semistructured interviews were conducted to Japanese physicians who participated in the four-hour VitalTalk training in Japanese. We explored six majored themes: 1) global impression of the training; 2) main goals from participation; 3) appropriateness of didactics; 4) role play experiences; 5) take away points from the training; and 6) changes in their own communication practice after the training. Interviews were transcribed, coded, and analyzed using phenomenological approach. RESULTS All 24 participants found the VitalTalk pedagogy novel and beneficial, stressing the importance of demonstrating empathy, reflecting on own skills, and recognizing the importance of feedback that emphasizes the use of specific words. Participants also pointed out that Japanese patients generally do not express their strong emotions explicitly. CONCLUSION Our study found empirical evidence that the VitalTalk pedagogy is perceived to be novel and beneficial in a non-US cultural setting. Cultural adaptations in expression and response to emotion may be required to maximize its efficacy in Japan. To meet the needs of clinical practice in Japan, further studies are needed to empirically test the suggested refinements for the VitalTalk pedagogy.
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Affiliation(s)
- Eriko Onishi
- Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, USA.
| | - Shunichi Nakagawa
- Adult Palliative Care Services, Columbia University, New York, New York, USA
| | - Takeshi Uemura
- University Health Partners of Hawaii, Honolulu, Hawaii, USA
| | | | | | - Kaori Ito
- Division of Acute Care Surgery, Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Yuki Kobayashi
- Teikyo University Graduate School of Public Health, Tokyo, Japan
| | - Hirono Ishikawa
- Teikyo University Graduate School of Public Health, Tokyo, Japan
| | - Kei Ouchi
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA; Serious illness care program, Ariadne Labs, Boston, Massachusetts, USA
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Chung FR, Turecamo S, Cuthel AM, Grudzen CR. Effectiveness and Reach of the Primary Palliative Care for Emergency Medicine (PRIM-ER) Pilot Study: a Qualitative Analysis. J Gen Intern Med 2021; 36:296-304. [PMID: 33111240 PMCID: PMC7878660 DOI: 10.1007/s11606-020-06302-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 10/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Palliative care interventions in the ED capture high-risk patients at a time of crisis and can dramatically improve patient-centered outcomes. OBJECTIVE To understand the facilitators that contributed to the success of the Primary Palliative Care for Emergency Medicine (PRIM-ER) quality improvement pilot intervention. DESIGN Effectiveness was evaluated through semi-structured interviews. Reach outcomes were measured by percent of all full-time emergency providers (physicians, physician assistants, nurses) who completed the intervention education components and baseline survey assessing attitudes and knowledge on end-of-life care. PARTICIPANTS Emergency medicine providers affiliated with two medical centers (N = 197). Interviews conducted with six key informants at both institutions. APPROACH Interviews were recorded, transcribed, and analyzed using deductive and inductive approaches. Descriptive statistics include reach outcomes and baseline survey results. KEY RESULTS Both sites successfully implemented all components of the intervention and achieved a high level (> 75%) of intervention reach. Two themes emerged as facilitators to successful effectiveness facilitators of PRIM-ER: (1) institutional leadership support and (2) leveraging established quality improvement (QI) processes. Institutional support included leveraging leadership with authority to (a) mandate trainings; (b) substitute PRIM-ER education for normally scheduled education; and (c) provide protected time to implement intervention components. Effectiveness was also enhanced by capitalizing on existing QI processes which included (a) leveraging interdisciplinary partnerships and communication plans and (b) monitoring performance improvement data. CONCLUSIONS Capitalizing on strong institutional leadership support and established QI processes enhanced the reach and effectiveness of the PRIM-ER pilot. These findings will guide the PRIM-ER researchers in scaling up the intervention in the remaining 33 sites, as well as enhance the planning of other complex quality improvement interventions in clinical settings. REGISTRATION DETAILS ClinicalTrials.gov Identifier: NCT03424109; Grant Number: AT009844-01.
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Affiliation(s)
- Frank R Chung
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, 227 East 30th Street, 117, New York, NY, 10016, USA
| | - Sarah Turecamo
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, 227 East 30th Street, 117, New York, NY, 10016, USA
| | - Allison M Cuthel
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, 227 East 30th Street, 117, New York, NY, 10016, USA.
| | - Corita R Grudzen
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, 227 East 30th Street, 117, New York, NY, 10016, USA
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Ong ZH, Tan LHE, Ghazali HZB, Ong YT, Koh JWH, Ang RZE, Bok C, Chiam M, Lee ASI, Chin AMC, Zhou JX, Chan GWH, Nadarajan GD, Krishna LKR. A Systematic Scoping Review on Pedagogical Strategies of Interprofessional Communication for Physicians in Emergency Medicine. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2021; 8:23821205211041794. [PMID: 34671703 PMCID: PMC8521417 DOI: 10.1177/23821205211041794] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Interprofessional communication (IPC) is integral to interprofessional teams working in the emergency medicine (EM) setting. Yet, the coronavirus disease 2019 pandemic has laid bare gaps in IPC knowledge, skills and attitudes. These experiences underscore the need to review how IPC is taught in EM. PURPOSE A systematic scoping review is proposed to scrutinize accounts of IPC programs in EM. METHODS Krishna's Systematic Evidence-Based Approach (SEBA) is adopted to guide this systematic scoping review. Independent searches of ninedatabases (PubMed, Embase, CINAHL, Scopus, PsycINFO, ERIC, JSTOR, Google Scholar and OpenGrey) and "negotiated consensual validation" were used to identify articles published between January 1, 2000 and December 31, 2020. Three research teams reviewed the data using concurrent content and thematic analysis and independently summarized the included articles. The findings were scrutinized using SEBA's jigsaw perspective and funneling approach to provide a more holistic picture of the data. RESULTS IN TOTAL 18,809 titles and abstracts were identified after removal of duplicates, 76 full-text articles reviewed, and 19 full-text articles were analyzed. In total, four themes and categories were identified, namely: (a) indications and outcomes, (2) curriculum and assessment methods, (3) barriers, and (4) enablers. CONCLUSION IPC training in EM should be longitudinal, competency- and stage-based, underlining the need for effective oversight by the host organization. It also suggests a role for portfolios and the importance of continuing support for physicians in EM as they hone their IPC skills. HIGHLIGHTS • IPC training in EM is competency-based and organized around stages.• IPC competencies build on prevailing knowledge and skills.• Longitudinal support and holistic oversight necessitates a central role for the host organization.• Longitudinal, robust, and adaptable assessment tools in the EM setting are necessary and may be supplemented by portfolio use.
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Affiliation(s)
- Zhi H. Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Lorraine H. E. Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | | | - Yun T. Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Jeffrey W. H. Koh
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- National University of Singapore, Singapore
| | - Rachel Z. E. Ang
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore
| | - Chermaine Bok
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
| | - Alexia S. I. Lee
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
| | | | - Jamie X. Zhou
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
- Duke-NUS Medical School, Singapore
| | - Gene W. H. Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- National University Hospital, National University Health System, Singapore
| | | | - Lalit K. R. Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, UK
- Centre for Biomedical Ethics, National University of Singapore, Singapore
- PalC, The Palliative Care Centre for Excellence in Research and Education, Singapore
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Managing Code Status Conversations for Seriously Ill Older Adults in Respiratory Failure. Ann Emerg Med 2020; 76:751-756. [PMID: 32747084 DOI: 10.1016/j.annemergmed.2020.05.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Indexed: 11/21/2022]
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27
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Kirca N, Bademli K. Relationship between communication skills and care behaviors of nurses. Perspect Psychiatr Care 2019; 55:624-631. [PMID: 30990906 DOI: 10.1111/ppc.12381] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 03/25/2019] [Accepted: 03/30/2019] [Indexed: 11/29/2022] Open
Abstract
PURPOSE In this study, we aimed to determine the relationship between communication competence and patient care behaviors of nurses. DESIGN AND METHODS The study was designed as a descriptive relational study and conducted in Akdeniz University Hospital between March 2018 and May 2018. Data of this study were collected from clinical nurses working in Akdeniz University Hospital. The study was carried out with 262 nurses who accepted to agreed participate in the study. FINDINGS Of all nurses, 97% were college graduates, 63% were married, and 35% had working experience between 5 and 9 years. There was a moderate positive correlation between communicative competence and care behaviors of nurses (r = 0.5, P < 0.01). PRACTICE IMPLICATIONS More training can be implemented to educate nurses about communication barriers to equip them with effective communication skills and strategies. The nursing process is a scientific method of exercising and implementing of nursing care, this is only achieved through dialogue, interpersonal environment, and specific verbal and nonverbal communication skills. In service training of nurses on effective communicative techniques will inevitably have a positive impact rather than reflection on patient care.
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Affiliation(s)
- Nurcan Kirca
- Department of Obstetrics & Gynecological Nursing, Faculty of Nursing, Akdeniz University, Antalya, Turkey
| | - Kerime Bademli
- Department of Psychiatric Nursing, Faculty of Nursing, Akdeniz University, Antalya, Turkey
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Nakagawa S, Fischkoff K, Berlin A, Arnell TD, Blinderman CD. Communication Skills Training for General Surgery Residents. JOURNAL OF SURGICAL EDUCATION 2019; 76:1223-1230. [PMID: 31005480 DOI: 10.1016/j.jsurg.2019.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/19/2019] [Accepted: 04/02/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Although good communication skills are essential for surgeons, there is no formal communication training during general surgery residency. OBJECTIVES To implement a communication skills training program based on evidence-based teaching methods in general surgery residency. DESIGN We developed a 2-hour communication skills training program for general surgery residents, consisting of a small group skill practice session using role play with simulated patients along with real-time feedback from facilitators and observing peer residents. A board-certified palliative care physician and a board-certified surgeon facilitated each session. Outcome measures were self-assessment of preparedness with the session immediately before and after the session and 2 months after the session, resident satisfaction, and self-report frequency of skill practice. Results were compared between junior residents (postgraduate year 1-3) and senior residents (postgraduate year 4-5). SETTING Columbia University Medical Center in New York City, a tertiary care, urban academic center with a 5-year General Surgery Residency program. PARTICIPANTS Thirty-one out of 39 (79.4%) general surgery residents (20 junior and 11 senior) were trained over a 9-month period. All participants completed the immediate pre- and post-session surveys, and twenty residents (64.5%) completed the 2-month postsession follow-up survey. RESULTS Overall, self-assessment of preparedness for specific communication challenges improved significantly for 7 of 11 tasks. At baseline, senior residents felt significantly more prepared than junior residents in all 11 tasks. Junior residents' self-assessment of preparedness improved significantly in 10 of 11 tasks. Overall satisfaction with the session was very high (mean 4.74 on a 5-point scale). Residents reported high frequency of self-directed skill practice in the 2-month follow-up survey. CONCLUSIONS This 2-hour communication skills practice session for general surgery residents was feasible, and it improved resident self-assessment of preparedness in communication and augmented self-directed skill practice.
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Affiliation(s)
- Shunichi Nakagawa
- Department of Medicine, Adult Palliative Care Services, Columbia University Medical Center, New York, New York.
| | - Katherine Fischkoff
- Department of Surgery, Division of General Surgery, Columbia University Medical Center, New York, New York
| | - Ana Berlin
- Department of Medicine, Adult Palliative Care Services, Columbia University Medical Center, New York, New York; Department of Surgery, Division of General Surgery, Columbia University Medical Center, New York, New York
| | - Tracey D Arnell
- Department of Surgery, Division of General Surgery, Columbia University Medical Center, New York, New York
| | - Craig D Blinderman
- Department of Medicine, Adult Palliative Care Services, Columbia University Medical Center, New York, New York
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Ouchi K, George N, Schuur JD, Aaronson EL, Lindvall C, Bernstein E, Sudore RL, Schonberg MA, Block SD, Tulsky JA. Goals-of-Care Conversations for Older Adults With Serious Illness in the Emergency Department: Challenges and Opportunities. Ann Emerg Med 2019; 74:276-284. [PMID: 30770207 PMCID: PMC6714052 DOI: 10.1016/j.annemergmed.2019.01.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 12/20/2018] [Accepted: 12/31/2018] [Indexed: 12/13/2022]
Abstract
During the last 6 months of life, 75% of older adults with preexisting serious illness, such as advanced heart failure, lung disease, and cancer, visit the emergency department (ED). ED visits often mark an inflection point in these patients' illness trajectories, signaling a more rapid rate of decline. Although most patients are there seeking care for acute issues, many of them have priorities other than to simply live as long as possible; yet without discussion of preferences for treatment, they are at risk of receiving care not aligned with their goals. An ED visit may offer a unique "teachable moment" to empower patients to consider their ability to influence future medical care decisions. However, the constraints of the ED setting pose specific challenges, and little research exists to guide clinicians treating patients in this setting. We describe the current state of goals-of-care conversations in the ED, outline the challenges to conducting these conversations, and recommend a research agenda to better equip emergency physicians to guide shared decisionmaking for end-of-life care. Applying best practices for serious illness communication may help emergency physicians empower such patients to align their future medical care with their values and goals.
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Affiliation(s)
- Kei Ouchi
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA; Department of Emergency Medicine, Harvard Medical School, Boston, MA; Serious Illness Care Program, Ariadne Labs, Boston, MA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA.
| | - Naomi George
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA; Department of Emergency Medicine, Harvard Medical School, Boston, MA
| | - Jeremiah D Schuur
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA; Department of Emergency Medicine, Harvard Medical School, Boston, MA
| | - Emily L Aaronson
- Department of Emergency Medicine, Harvard Medical School, Boston, MA; Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Charlotta Lindvall
- Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA; Department of Medicine, Division of Palliative Medicine, Brigham and Women's Hospital, Boston, MA
| | - Edward Bernstein
- The Brief Negotiated Interview Active Referral to Treatment Institute, Boston University School of Public Health, and the Department of Emergency Medicine, Boston University School of Medicine, Boston, MA
| | - Rebecca L Sudore
- Department of Medicine, University of California, San Francisco, CA
| | - Mara A Schonberg
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Susan D Block
- Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Serious Illness Care Program, Ariadne Labs, Boston, MA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA; Department of Psychiatry, Brigham and Women's Hospital, Boston, MA
| | - James A Tulsky
- Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA; Department of Medicine, Division of Palliative Medicine, Brigham and Women's Hospital, Boston, MA
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Grudzen CR, Brody AA, Chung FR, Cuthel AM, Mann D, McQuilkin JA, Rubin AL, Swartz J, Tan A, Goldfeld KS. Primary Palliative Care for Emergency Medicine (PRIM-ER): Protocol for a Pragmatic, Cluster-Randomised, Stepped Wedge Design to Test the Effectiveness of Primary Palliative Care Education, Training and Technical Support for Emergency Medicine. BMJ Open 2019; 9:e030099. [PMID: 31352424 PMCID: PMC6661655 DOI: 10.1136/bmjopen-2019-030099] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Emergency departments (ED) care for society's most vulnerable older adults who present with exacerbations of chronic disease at the end of life, yet the clinical paradigm focuses on treatment of acute pathologies. Palliative care interventions in the ED capture high-risk patients at a time of crisis and can dramatically improve patient-centred outcomes. This study aims to implement and evaluate Primary Palliative Care for Emergency Medicine (PRIM-ER) on ED disposition, healthcare utilisation and survival in older adults with serious illness. METHODS AND ANALYSIS This is the protocol for a pragmatic, cluster-randomised stepped wedge trial to test the effectiveness of PRIM-ER in 35 EDs across the USA. The intervention includes four core components: (1) evidence-based, multidisciplinary primary palliative care education; (2) simulation-based workshops; (3) clinical decision support; and (4) audit and feedback. The study is divided into two phases: a pilot phase, to ensure feasibility in two sites, and an implementation and evaluation phase, where we implement the intervention and test the effectiveness in 33 EDs over 2 years. Using Centers for Medicare and Medicaid Services (CMS) data, we will assess the primary outcomes in approximately 300 000 patients: ED disposition to an acute care setting, healthcare utilisation in the 6 months following the ED visit and survival following the index ED visit. Analysis will also determine the site, provider and patient-level characteristics that are associated with variation in impact of PRIM-ER. ETHICS AND DISSEMINATION Institutional Review Board approval was obtained at New York University School of Medicine to evaluate the CMS data. Oversight will also be provided by the National Institutes of Health, an Independent Monitoring Committee and a Clinical Informatics Advisory Board. Trial results will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT03424109; Pre-results.
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Affiliation(s)
- Corita R Grudzen
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York City, New York, USA
- Department of Population Health, New York University School of Medicine, New York City, New York, USA
| | - Abraham A Brody
- Hartford Institute for Geriatric Nursing, New York University Rory Meyers College of Nursing, New York City, New York, USA
| | - Frank R Chung
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York City, New York, USA
| | - Allison M Cuthel
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York City, New York, USA
- Department of Population Health, New York University School of Medicine, New York City, New York, USA
| | - Devin Mann
- Department of Population Health, New York University School of Medicine, New York City, New York, USA
- Medical Center Information Technology, NYU Langone Health, New York, New York, USA
| | - Jordan A McQuilkin
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York City, New York, USA
| | - Ada L Rubin
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York City, New York, USA
| | - Jordan Swartz
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York City, New York, USA
| | - Audrey Tan
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York City, New York, USA
| | - Keith S Goldfeld
- Department of Population Health, New York University School of Medicine, New York City, New York, USA
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Where do goals of care conversations belong? A case for the emergency department. CAN J EMERG MED 2019; 21:698-700. [DOI: 10.1017/cem.2019.364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Ringer T, Dougherty M, McQuown C, Melady D, Ouchi K, Southerland LT, Hogan TM. White Paper-Geriatric Emergency Medicine Education: Current State, Challenges, and Recommendations to Enhance the Emergency Care of Older Adults. AEM EDUCATION AND TRAINING 2018; 2:S5-S16. [PMID: 30607374 PMCID: PMC6304282 DOI: 10.1002/aet2.10205] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 10/02/2018] [Indexed: 05/21/2023]
Abstract
Older adults account for 25% of all emergency department (ED) patient encounters. One in five Americans will be 65 or older by 2030. In response to this need, geriatric emergency medicine (GEM) has developed into a robust area of academic and clinical interest, with extensive evidence-based research and guidelines, including clear undergraduate and postgraduate GEM competencies. Despite these developments, GEM content remains underrepresented in curricula and licensing examinations. The complex reasons for these deficits include a perception that care of older adults is not a core emergency medicine (EM) competency, a disjunction between traditional definitions of expertise and the GEM perspective, and lack of curricular capacity. This White Paper, prepared on behalf of the Academy of Geriatric Emergency Medicine, describes the state of GEM education, identifies the challenges it faces, and reviews innovations, including research presented at the 2018 Society for Academic Emergency Medicine (SAEM) Annual Scientific Meeting. The authors propose a number of recommendations. These include recognizing GEM as a core educational priority in EM, enhancing academic support for GEM clinician-educators, using social learning and practical problem solving to teach GEM concepts, emphasizing a whole-person multisystem approach to care of older adults, and identifying ageist attitudes as a hurdle to safe and effective GEM care.
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Affiliation(s)
- Thom Ringer
- Mount Sinai Academic Family Health TeamTorontoOntarioCanada
| | | | - Colleen McQuown
- Northeast Ohio Medical UniversityRootstownOH
- Academic & Community Emergency SpecialistsLLCUniontownOH
| | - Don Melady
- Schwarz/Reisman Emergency Medicine InstituteDepartment of Family and Community MedicineSinai Health SystemUniversity of TorontoTorontoOntarioCanada
| | - Kei Ouchi
- Brigham and Women's HospitalHarvard Medical SchoolBostonMA
| | - Lauren T. Southerland
- Department of Emergency MedicineThe Ohio State University Wexner Medical CenterColumbusOH
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Pilnick A, Trusson D, Beeke S, O’Brien R, Goldberg S, Harwood RH. Using conversation analysis to inform role play and simulated interaction in communications skills training for healthcare professionals: identifying avenues for further development through a scoping review. BMC MEDICAL EDUCATION 2018; 18:267. [PMID: 30453956 PMCID: PMC6245918 DOI: 10.1186/s12909-018-1381-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 11/05/2018] [Indexed: 05/09/2023]
Abstract
BACKGROUND This paper responds to previously published debate in this journal around the use of sociolinguistic methods in communication skills training (CST), which has raised the significant question of how far consultations with simulated patients reflect real clinical encounters. This debate concluded with a suggestion that sociolinguistic methods offer an alternative analytic lens for evaluating CST. We demonstrate here that the utility of sociolinguistic methods in CST is not limited to critique, but also presents an important tool for development and delivery. METHODS Following a scoping review of the use of role play and simulated interaction in CST for healthcare professionals, we consider the use of the specific sociolinguistic approach of conversation analysis (CA), which has been applied to the study of health communication in a wide range of settings, as well as to the development of training. DISCUSSION Role play and simulated interaction have been criticised by both clinicians and sociolinguists for a lack of authenticity as compared to real life interactions. However they contain a number of aspects which healthcare professionals report finding particularly useful: the need to think on one's feet in real time, as in actual interaction with patients; the ability to receive feedback on the simulation; and the ability to watch and reflect on how others approach the same simulation task in real time. Since sociolinguistic approaches can help to identify inauthenticity in role play and simulation, they can also be used to improve authenticity. Analysis of real-life interactions using sociolinguistic methods, and CA in particular, can identify actual interactional practices that are used by particular patient groups. These practices can then be used to inform the training of actors simulating patients. In addition, the emphasis of CA on talk as joint activity means that proper account can be taken of the way in which simulated interaction is co-constructed between simulator and trainee. We suggest that as well as identifying potential weaknesses in current role play and simulation practice, conversation analysis offers the potential to enhance and develop the authenticity of these training methods.
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Affiliation(s)
- Alison Pilnick
- School of Sociology and Social Policy, University of Nottingham, Nottingham, NG7 2RD UK
| | - Diane Trusson
- Institute for Mental Health, University of Nottingham, Nottingham, UK
| | - Suzanne Beeke
- Language and Cognition Research Department, University College London, London, UK
| | - Rebecca O’Brien
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Sarah Goldberg
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Rowan H. Harwood
- School of Health Sciences, University of Nottingham, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
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Aaronson EL, White BA, Black L, Brown DF, Benzer T, Castagna A, Raja AS, Sonis J, Mort E. Training to Improve Communication Quality: An Efficient Interdisciplinary Experience for Emergency Department Clinicians. Am J Med Qual 2018; 34:260-265. [PMID: 30235933 DOI: 10.1177/1062860618799936] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patient-provider communication has been recognized as a critical area of focus for improved health care quality, with a mounting body of evidence tying patient satisfaction and provider communication to important health care outcomes. Despite this, few programs have been studied in the emergency department (ED) setting. The authors designed a communication curriculum and conducted trainings for all ED clinical staff. Although only 72% of clinicians believed the course would be a valuable use of their time before taking it, 97% reported that it was a valuable use of their time after ( P < .001). Pre-course self-evaluation of knowledge, skill, and ability were high. Despite this, post-course self-efficacy improved statistically significantly. This study suggests that it is possible, in a brief training session, to deliver communication content that participants felt was relevant to their practice, improved their skills and knowledge, changed their attitude, and was perceived to be a valuable use of their time.
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Affiliation(s)
- Emily L Aaronson
- 1 Massachusetts General Hospital, Harvard Medical School, Boston, MA.,2 Massachusetts General Hospital and Massachusetts General Physicians' Organization, Boston, MA
| | - Benjamin A White
- 1 Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Lauren Black
- 1 Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - David F Brown
- 1 Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Theodore Benzer
- 1 Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Allison Castagna
- 1 Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ali S Raja
- 1 Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Jonathan Sonis
- 1 Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Elizabeth Mort
- 1 Massachusetts General Hospital, Harvard Medical School, Boston, MA.,2 Massachusetts General Hospital and Massachusetts General Physicians' Organization, Boston, MA
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Wright RJ, Lowton K, Robert G, Grudzen CR, Grocott P. Emergency department staff priorities for improving palliative care provision for older people: A qualitative study. Palliat Med 2018; 32:417-425. [PMID: 28429643 DOI: 10.1177/0269216317705789] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Emergency department-based palliative care services are increasing, but research to develop these services rarely includes input from emergency clinicians, jeopardizing the effectiveness of subsequent palliative care interventions. AIM To collaboratively identify with emergency clinicians' improvement priorities for emergency department-based palliative care for older people. DESIGN This was one component of an experience-based co-design project, conducted using semi-structured interviews and feedback sessions. SETTING/PARTICIPANTS In-depth interviews with 15 emergency clinicians (nurses and doctors) at a large teaching hospital emergency department in the United Kingdom exploring experiences of palliative care delivery for older people. A thematic analysis identified core challenges that were presented to 64 clinicians over five feedback sessions, validating interview findings, and identifying shared priorities for improving palliative care delivery. RESULTS Eight challenges emerged: patient age; access to information; communication with patients, family members, and clinicians; understanding of palliative care; role uncertainty; complex systems and processes; time constraints; and limited training and education. Through feedback sessions, clinicians selected four challenges as improvement priorities: time constraints; communication and information; systems and processes; and understanding of palliative care. As resulting improvement plans evolved, "training and education" replaced "time constraints" as a priority. CONCLUSION Clinician priorities for improving emergency department-based palliative care were identified through collaborative, iterative processes. Though generally aware of older palliative patients' needs, clinicians struggled to provide high-quality care due to a range of complex factors. Further research should identify whether priorities are shared across other emergency departments, and develop, implement, and evaluate strategies developed by clinicians.
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Affiliation(s)
- Rebecca J Wright
- 1 Florence Nightingale Faculty of Nursing & Midwifery, King's College London, London, UK.,2 Ronald O. Perelman Department of Emergency Medicine, School of Medicine, New York University, New York, NY, USA
| | - Karen Lowton
- 3 Department of Sociology, University of Sussex, Brighton, UK
| | - Glenn Robert
- 1 Florence Nightingale Faculty of Nursing & Midwifery, King's College London, London, UK
| | - Corita R Grudzen
- 2 Ronald O. Perelman Department of Emergency Medicine, School of Medicine, New York University, New York, NY, USA
| | - Patricia Grocott
- 1 Florence Nightingale Faculty of Nursing & Midwifery, King's College London, London, UK
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Wang DH. Beyond Code Status: Palliative Care Begins in the Emergency Department. Ann Emerg Med 2017; 69:437-443. [DOI: 10.1016/j.annemergmed.2016.10.027] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Indexed: 11/29/2022]
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Arendts G, Carpenter CR, Hullick C, Burkett E, Nagaraj G, Rogers IR. Approach to death in the older emergency department patient. Emerg Med Australas 2016; 28:730-734. [DOI: 10.1111/1742-6723.12678] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 07/25/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Glenn Arendts
- Emergency Medicine; The University of Western Australia; Perth Western Australia Australia
- Harry Perkins Institute for Medical Research; Perth Western Australia Australia
| | | | - Carolyn Hullick
- Emergency Department; John Hunter Hospital; Newcastle New South Wales Australia
| | - Ellen Burkett
- Princess Alexandra Hospital; Brisbane Queensland Australia
| | - Guruprasad Nagaraj
- Hornsby and Royal North Shore Hospitals; Sydney New South Wales Australia
- School of Medicine; The University of Sydney; Sydney New South Wales Australia
| | - Ian R Rogers
- The University of Notre Dame; Fremantle Western Australia Australia
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