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Morgan DD, Litster C, Winsall M, Devery K, Rawlings D. "It's given me confidence": a pragmatic qualitative evaluation exploring the perceived benefits of online end-of-life education on clinical care. BMC Palliat Care 2021; 20:57. [PMID: 33849499 PMCID: PMC8043428 DOI: 10.1186/s12904-021-00753-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 04/08/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Hospital admissions for end-of-life care are increasing exponentially across the world. Significant numbers of health professionals are now required to provide end-of-life care with minimal training. Many health professionals report they lack confidence to provide this care, particularly those in acute hospital settings. This study explored the perceived benefits of online education on health professionals' capacity to provide end-of-life care. METHODS This qualitative study adopted a pragmatic approach. Thirty semi-structured interviews were conducted with allied health professionals, nurses and doctors who had completed a minimum of three End-of-Life Essentials online education modules. Interviews were held on line and face-to-face, audio-recorded and transcribed verbatim. Demographic data were also collected. Three major themes and one minor theme were constructed from the data using inductive thematic analysis. RESULTS Themes were (1). Perceptions of preparedness to provide end-of-life care, (2). Shifts in approaching end-of-life discussions and (3). Motivation for engagement with online modules. Participants reported validation of knowledge and improved confidence to have end-of-life discussions with patients, carers and team members. They also noted improved ability to recognise the dying process and improved conversations with team members about patient and carer needs. Videos portraying a novice and then more able end-of-life discussions were particularly valued by participants. Modules provided practical guidance on how to engage in discussions about the end of life and care needs. Participants were self-motivated to improve their knowledge and skills to enhance end-of-life care provision. Continuing professional development requirements were also a motivator for module completion. CONCLUSIONS This study explored health professionals' perspectives about the perceived benefits of online education modules on their clinical practice. Module completion enhanced participant confidence and self-reported improved competence in end-of-life care provision. Findings build on existing research that supports the valuable role online education plays in supporting confidence and ability to actively engage with patients, carers and colleagues about provision of end-of-life care; however, self-report cannot be used as a proxy for improved clinical competence.
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Affiliation(s)
- Deidre D Morgan
- Palliative and Supportive Services, College Nursing and Health Sciences, Flinders University, South Australia, Adelaide, Australia. .,Research Centre for Palliative Care, Death and Dying, Flinders University, South Australia, Adelaide, Australia.
| | - Caroline Litster
- Palliative and Supportive Services, College Nursing and Health Sciences, Flinders University, South Australia, Adelaide, Australia.,Research Centre for Palliative Care, Death and Dying, Flinders University, South Australia, Adelaide, Australia
| | - Megan Winsall
- Palliative and Supportive Services, College Nursing and Health Sciences, Flinders University, South Australia, Adelaide, Australia
| | - Kim Devery
- Palliative and Supportive Services, College Nursing and Health Sciences, Flinders University, South Australia, Adelaide, Australia.,Research Centre for Palliative Care, Death and Dying, Flinders University, South Australia, Adelaide, Australia
| | - Deb Rawlings
- Palliative and Supportive Services, College Nursing and Health Sciences, Flinders University, South Australia, Adelaide, Australia.,Research Centre for Palliative Care, Death and Dying, Flinders University, South Australia, Adelaide, Australia
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Boland JW, Brown MEL, Duenas A, Finn GM, Gibbins J. How effective is undergraduate palliative care teaching for medical students? A systematic literature review. BMJ Open 2020; 10:e036458. [PMID: 32912945 PMCID: PMC7482461 DOI: 10.1136/bmjopen-2019-036458] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
UNLABELLED Palliative care is central to the role of all clinical doctors. There is variability in the amount and type of teaching about palliative care at undergraduate level. Time allocated for such teaching within the undergraduate medical curricula remains scarce. Given this, the effectiveness of palliative care teaching needs to be known. OBJECTIVES To evaluate the effectiveness of palliative care teaching for undergraduate medical students. DESIGN A systematic review was prepared according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. Screening, data extraction and quality assessment (mixed methods and Cochrane risk of bias tool) were performed in duplicate. DATA SOURCES Embase, MEDLINE, PsycINFO, Web of Science, ClinicalTrials.gov, Cochrane and grey literature in August 2019. Studies evaluating palliative care teaching interventions with medical students were included. RESULTS 1446 titles/abstracts and 122 full-text articles were screened. 19 studies were included with 3253 participants. 17 of the varied methods palliative care teaching interventions improved knowledge outcomes. The effect of teaching on clinical practice and patient outcomes was not evaluated in any study. CONCLUSIONS The majority of palliative care teaching interventions reviewed improved knowledge of medical students. The studies did not show one type of teaching method to be better than others, and thus no 'best way' to provide teaching about palliative care was identified. High quality, comparative research is needed to further understand effectiveness of palliative care teaching on patient care/clinical practice/outcomes in the short-term and longer-term. PROSPERO REGISTRATION NUMBER CRD42018115257.
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Affiliation(s)
- Jason W Boland
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Megan E L Brown
- Health Professions Education Unit, Hull York Medical School, York, UK
| | - Angelique Duenas
- Health Professions Education Unit, Hull York Medical School, York, UK
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Bush SH, Gratton V, Kabir M, Enright P, Grassau PA, Rice J, Hall P. Building a Medical Undergraduate Palliative Care Curriculum: Lessons Learned. J Palliat Care 2020; 36:29-37. [PMID: 32284024 DOI: 10.1177/0825859720916565] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Previous literature demonstrates that current palliative care training is in need of improvement for medical students in global, European and Canadian contexts. The training of medical undergraduates is key to ensure that the ongoing and increasing need for enhanced access to palliative care across all settings and communities is met. We describe building a comprehensive palliative and end-of-life care curriculum for medical undergraduates at our university. As with recent European and US studies, we found that the process of university curriculum renewal provided a critical opportunity to integrate palliative care content, but needed a local palliative care champion already in place as an energetic and tireless advocate. The development and integration of a substantive bilingual (English and French) palliative and end-of-life care curriculum over the 4-year medical undergraduate program at our university has occurred over the course of 14 years, and required multiple steps and initiatives. Subsequent to the development of the curriculum, there has been a 13-fold increase in students selecting our palliative care clinical rotations. Critical lessons learned speak to the importance of having a team vision, interprofessional collaboration with a focus on vision, plans and implementation, and flexibility to actively respond and further integrate new educational opportunities within the curriculum. Future directions for our palliative care curriculum include shifting to a competency-based training and evaluation paradigm. Our findings and lessons learned may help others who are working to develop a comprehensive undergraduate medical education curriculum.
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Affiliation(s)
- Shirley H Bush
- Division of Palliative Care, Department of Medicine, 6363University of Ottawa, Ottawa, Canada.,152971Bruyère Research Institute, Ottawa, Canada.,Ottawa Hospital Research Institute, Ottawa, Canada.,Bruyère Continuing Care, Ottawa, Canada
| | - Valérie Gratton
- Division of Palliative Care, Department of Medicine, 6363University of Ottawa, Ottawa, Canada.,Institut du Savoir Montfort, Ottawa, Canada.,Hôpital Montfort, Ottawa, Canada
| | | | - Paula Enright
- Division of Palliative Care, Department of Medicine, 6363University of Ottawa, Ottawa, Canada
| | - Pamela A Grassau
- Division of Palliative Care, Department of Medicine, 6363University of Ottawa, Ottawa, Canada.,152971Bruyère Research Institute, Ottawa, Canada.,School of Social Work, Carleton University, Ottawa, Canada
| | - Jill Rice
- Division of Palliative Care, Department of Medicine, 6363University of Ottawa, Ottawa, Canada.,152971Bruyère Research Institute, Ottawa, Canada.,Ottawa Hospital Research Institute, Ottawa, Canada.,Bruyère Continuing Care, Ottawa, Canada
| | - Pippa Hall
- Division of Palliative Care, Department of Medicine, 6363University of Ottawa, Ottawa, Canada
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White N, Oostendorp LJM, Tomlinson C, Yardley S, Ricciardi F, Gökalp H, Minton O, Boland JW, Clark B, Harries P, Stone P. Online training improves medical students' ability to recognise when a person is dying: The ORaClES randomised controlled trial. Palliat Med 2020; 34:134-144. [PMID: 31722611 PMCID: PMC6952943 DOI: 10.1177/0269216319880767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recognising dying is a key clinical skill for doctors, yet there is little training. AIM To assess the effectiveness of an online training resource designed to enhance medical students' ability to recognise dying. DESIGN Online multicentre double-blind randomised controlled trial (NCT03360812). The training resource for the intervention group was developed from a group of expert palliative care doctors' weightings of various signs/symptoms to recognise dying. The control group received no training. SETTING/PARTICIPANTS Participants were senior UK medical students. They reviewed 92 patient summaries and provided a probability of death within 72 hours (0% certain survival - 100% certain death) pre, post, and 2 weeks after the training. Primary outcome: (1) Mean Absolute Difference (MAD) score between participants' and the experts' scores, immediately post intervention. Secondary outcomes: (2) weight attributed to each factor, (3) learning effect and (4) level of expertise (Cochran-Weiss-Shanteau (CWS)). RESULTS Out of 168 participants, 135 completed the trial (80%); 66 received the intervention (49%). After using the training resource, the intervention group had better agreement with the experts in their survival estimates (δMAD = -3.43, 95% CI -0.11 to -0.34, p = <0.001) and weighting of clinical factors. There was no learning effect of the MAD scores at the 2-week time point (δMAD = 1.50, 95% CI -0.87 to 3.86, p = 0.21). At the 2-week time point, the intervention group was statistically more expert in their decision-making versus controls (intervention CWS = 146.04 (SD 140.21), control CWS = 110.75 (SD 104.05); p = 0.01). CONCLUSION The online training resource proved effective in altering the decision-making of medical students to agree more with expert decision-making.
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Affiliation(s)
- Nicola White
- Marie Curie Palliative Care Research
Department, Division of Psychiatry, University College London (UCL), London,
UK
| | - Linda JM Oostendorp
- Marie Curie Palliative Care Research
Department, Division of Psychiatry, University College London (UCL), London,
UK
| | | | - Sarah Yardley
- Marie Curie Palliative Care Research
Department, Division of Psychiatry, University College London (UCL), London,
UK
- Central and North West London NHS
Foundation Trust, London, UK
| | - Federico Ricciardi
- Marie Curie Palliative Care Research
Department, Division of Psychiatry, University College London (UCL), London,
UK
- Department of Statistical Science,
University College London (UCL), London, UK
| | - Hülya Gökalp
- Department of Electrical and Electronics
Engineering, Ondokuz Mayis University, Samsun, Turkey
- Department of Clinical Sciences, Brunel
University London, London, UK
| | - Ollie Minton
- Brighton and Sussex University Hospitals
NHS Trust, Brighton, UK
| | | | - Ben Clark
- Imperial College Healthcare NHS Trust,
London, UK
| | - Priscilla Harries
- Department of Clinical Sciences, Brunel
University London, London, UK
- Centre for Applied Health and Social
Care Research, Faculty of Health, Social Care and Education, Kingston University and
St George’s, University of London, London, UK
| | - Patrick Stone
- Marie Curie Palliative Care Research
Department, Division of Psychiatry, University College London (UCL), London,
UK
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