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Ayora A, Nogueras C, Jiménez-Panés S, Cortiñas-Rovira S. Teaching (remotely) to communicate (remotely) with relatives of patients during lockdown due to the COVID-19 pandemic. PEC INNOVATION 2023; 2:100151. [PMID: 37016635 PMCID: PMC10052879 DOI: 10.1016/j.pecinn.2023.100151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 03/06/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023]
Abstract
Aim In 2020, due to the pandemic, the lack of specific knowledge on breaking bad news over the phone became apparent. This study aims at assessing the differences, or lack thereof, in satisfaction reported by participants in the different formats of a course in telephone communication for breaking bad news to families of patients, developed based on the previous experience of a team dedicated to this task during the peak of the pandemic. Methods Four courses were delivered, two in a fully streamed format and two in a blended format, part pre-recorded, part streamed. There were 41 attendants, mostly doctors, but also nurses, social workers, occupational therapists, and administrative staff who deal with families. Subsequently, a survey was conducted to assess the degree of satisfaction of the participants. Results Both formats scored very positively, with small advantages for the fully streamed format, mainly due to the difference in interaction activities. Conclusions The main conclusion is the need for these courses, which are demanded by the professionals themselves, without forgetting the benefit obtained from interprofessional education that enriches interaction and learning. Innovation The inclusion of administrative staff allows for a global vision of care for family members, which improves it.
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Affiliation(s)
- Ara Ayora
- Scientific Communication Research Group (GRECC), Department of Communication, Universitat Pompeu Fabra, Barcelona, Spain
| | - Carme Nogueras
- Geriatric Department at Hospital Universitari Germans Trias i Pujol in Barcelona, Spain
| | | | - Sergi Cortiñas-Rovira
- Scientific Communication Research Group (GRECC), Department of Communication, Universitat Pompeu Fabra and UPF-BSM Barcelona School of Management, Barcelona, Spain
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Shiri S, Wexler I, Marmor A, Meiner Z, Schwartz I, Levzion Korach O, Azoulay D. Hospice Care: Hope and Meaning in Life Mediate Subjective Well-Being of Staff. Am J Hosp Palliat Care 2020; 37:785-790. [PMID: 32052661 DOI: 10.1177/1049909120905261] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Subjective well-being has been associated with decreased work burnout and elevated work engagement. We investigated the impact of hope and meaning in life on subjective well-being among workers in a hospice care setting. Comparison was made to health-care workers in a rehabilitation unit. METHODS Thirty-five hospice care workers were surveyed and their responses compared with those of 36 rehabilitation workers. Survey instruments measuring hope, meaning in life, work engagement, and satisfaction with life were utilized. RESULTS Individuals working in a hospice care center have significantly higher levels of work engagement than their counterparts in rehabilitation. For both groups, hope was significantly related to subjective well-being. For hospice care but not rehabilitation workers, meaning in life was also related to subjective well-being. Multivariate analysis showed that hope and meaning in life were independent factors predicting subjective well-being in hospice care workers. SIGNIFICANCE OF RESULTS Hospice care workers are highly engaged in their work despite the challenging nature of their work. What characterizes these workers is a level of subjective well-being that is related to both meaning in life and hope. Maintaining a high level of subjective well-being may be an important factor in preventing burnout among those working in hospice care settings.
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Affiliation(s)
- Shimon Shiri
- Department of Physical and Medical Rehabilitation, Hadassah University Hospital, Jerusalem, Israel.,Shimon Shiri, Isaiah Wexler, and Anat Marmor contributed equally to this work
| | - Isaiah Wexler
- Department of Pediatrics, Hadassah University Hospital, Jerusalem, Israel.,Shimon Shiri, Isaiah Wexler, and Anat Marmor contributed equally to this work
| | - Anat Marmor
- Department of Physical and Medical Rehabilitation, Hadassah University Hospital, Jerusalem, Israel.,Shimon Shiri, Isaiah Wexler, and Anat Marmor contributed equally to this work
| | - Zeev Meiner
- Department of Physical and Medical Rehabilitation, Hadassah University Hospital, Jerusalem, Israel
| | - Isabella Schwartz
- Department of Physical and Medical Rehabilitation, Hadassah University Hospital, Jerusalem, Israel
| | | | - Daniel Azoulay
- Hospice Unit, Hadassah University Hospital, Jerusalem, Israel
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Sokol RG, Shaughnessy AF. Making the Most of Continuing Medical Education: Evidence of Transformative Learning During a Course in Evidence-Based Medicine and Decision Making. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2018; 38:102-109. [PMID: 29851715 DOI: 10.1097/ceh.0000000000000199] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Continuing medical information courses have been criticized for not promoting behavior change among their participants. For behavior change to occur, participants often need to consciously reject previous ideas and transform their way of thinking. Transformational learning is a process that cultivates deep emotional responses and can lead to cognitive and behavioral change in learners, potentially facilitating rich learning experiences and expediting knowledge translation. We explored participants' experiences at a 2-day conference designed to support transformative learning as they encounter new concepts within Information Mastery, which challenge their previous frameworks around the topic of medical decision making. Using the lens of transformative learning theory, we asked: how does Information Mastery qualitatively promote perspective transformation and hence behavior change? METHODS We used a hermeneutic phenomenologic approach to capture the lived experience of 12 current and nine previous attendees of the "Information Mastery" course through individual interviews, focus groups, and observation. Data were thematically analyzed. RESULTS Both prevoius and current conference attendees described how the delivery of new concepts about medical decision making evoked strong emotional responses, facilitated personal transformation, and propelled expedited behavior change around epistemological, moral, and information management themes, resulting in a newfound sense of self-efficacy, confidence, and ownership in their ability to make medical decisions. DISCUSSION When the topic area holds the potential to foster a qualitative reframing of learners' guiding paradigms and worldviews, attention should be paid to supporting learners' personalized meaning-making process through transformative learning opportunities to promote translation into practice.
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Affiliation(s)
- Randi G Sokol
- Dr. Sokol: Assistant Professor of Family Medicine, Tufts Family Medicine Residency Program at Cambridge Health Alliance, Malden, MA. Dr. Shaughnessy: Professor of Family Medicine, Professor of Public Health and Community Medicine, Tufts University School of Medicine, Malden, MA
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Rodenbach RA, Rodenbach KE, Tejani MA, Epstein RM. Relationships between personal attitudes about death and communication with terminally ill patients: How oncology clinicians grapple with mortality. PATIENT EDUCATION AND COUNSELING 2016; 99:356-363. [PMID: 26519993 PMCID: PMC5955702 DOI: 10.1016/j.pec.2015.10.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 10/01/2015] [Accepted: 10/12/2015] [Indexed: 05/02/2023]
Abstract
OBJECTIVE Clinician discomfort with death may affect care of patients but has not been well-studied. This study explores oncology clinicians' attitudes surrounding their own death and how these attitudes both affect and are affected by their care of dying patients and their communication with them. METHODS Qualitative interviews with physicians (n=25), nurse practitioners (n=7), and physician assistants (n=1) in medical or hematologic oncology clinical practices about communication styles, care of terminally ill patients, and personal perspectives about mortality. RESULTS Clinicians described three communication styles used with patients about death and dying: direct, indirect, or selectively direct. Most reported an acceptance of their mortality that was "conditional," meaning that that they could not fully know how they would respond if actually terminally ill. For many clinicians, caring for dying patients affected their outlook on life and death, and their own perspectives on life and death affected their approach to caring for dying patients. CONCLUSION An awareness of personal mortality may help clinicians to discuss death more openly with patients and to provide better care. PRACTICE IMPLICATIONS Efforts to promote self-awareness and communication training are key to facilitating clear communication with and compassionate care of terminally ill patients.
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Affiliation(s)
- Rachel A Rodenbach
- University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY 14642, USA.
| | - Kyle E Rodenbach
- University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY 14642, USA
| | - Mohamedtaki A Tejani
- Department of Medicine, Hematology/Oncology, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, USA
| | - Ronald M Epstein
- Department of Family Medicine, University of Rochester Medical Center, 1381 South Ave, Rochester, NY 14620, USA
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Ilan S, Carmel S. Patient communication pattern scale: psychometric characteristics. Health Expect 2015; 19:842-53. [PMID: 26172267 PMCID: PMC5034838 DOI: 10.1111/hex.12381] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2015] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND In western societies, a shared decision-making model for doctor-patient relationships calling for open and collaborative communication is recommended. Research focuses mainly on the doctor's communication patterns, while research on patient communication patterns is rare. The purpose of this study was to develop a tool for evaluating patient's communication patterns - the Patient Communication Pattern Scale (PCPS). METHODS Interviews based on structured questionnaires were conducted with 251 cancer patients. In addition to the 14-item PCPS, the questionnaire included questions regarding education, religiosity and desirability of control in general and over one's own health in particular, for validating the scale. RESULTS The PCPS was found to be a valid and reliable tool for evaluating patients' communication patterns. Confirmatory factor analysis supported the PCPS designed structure of five facets: (1) Information, (2) Clarification, (3) Initiation, (4) Preferences and (5) Emotions. CONCLUSION The PCPS is a reliable scale for evaluating patient communication patterns. The use of this scale can assist in promoting related research and in developing interventions for enhancing open and collaborative doctor-patient communication.
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Affiliation(s)
- Sara Ilan
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Sara Carmel
- Head Center for Multidisciplinary Research in Aging, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Beringer AJ, Heckford EJ. Was there a plan? End-of-life care for children with life-limiting conditions: a review of multi-service healthcare records. Child Care Health Dev 2014. [PMID: 23198741 DOI: 10.1111/cch.12020] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Planning for care at the end of life (EoL) is an essential component of support and care for families of children with life-limiting conditions. The purpose of this review was to compare documented EoL planning with published children's palliative care standards, across a range of children's healthcare services and to assess the impact on practice of written guidelines to support EoL care planning. METHOD A manual retrospective review of healthcare records using a purpose-built form. Inclusion criteria were the records of children with a diagnosed life-limiting or life-threatening condition, who had died before the age of 18 years, between October 2008 and March 2010, within a defined geographical area served by one or more of the participating services. The sample was 114 sets of notes relating to a cohort of 48 children: 24 girls and 24 boys, the majority of whose deaths were cancer related. RESULTS Examples of good practice were found in the records of individual services. Services had each developed their own systems and documents to support EoL care planning rather than using a unified documentation system. Where documented practice fell short, this was related to a lack of evidence that choice in location of death had been offered, delays in sharing of information between services, and information being buried in the narrative of the notes, making it difficult to find. CONCLUSIONS Current documented EoL planning varies between services. Those who are infrequently involved in the provision of EoL care may benefit from support by those for whom this is part of their daily working life. These professionals can help prepare staff to engage families in these difficult but important conversations - and encourage them to document them in a way that can be easily and readily accessed and shared.
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Affiliation(s)
- A J Beringer
- Faculty of Health & Life Sciences, University of the West of England, Glenside Campus, Bristol, UK
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Duane TM, Fan L, Bohannon A, Han J, Wolfe L, Mayglothling J, Whelan J, Aboutanos M, Malhotra A, Ivatury RR. Geriatric Education for Surgical Residents: Identifying a Major Need. Am Surg 2011. [DOI: 10.1177/000313481107700714] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study evaluated a program designed to test and enhance residents’ knowledge of geriatrics. A 2-year prospective interventional trial was conducted. Surgical residents underwent pretesting (pre) in three areas: polypharmacy, delirium, and end of life. They then received educational materials and completed a posttest within 1 month and a patient simulation examination graded by a physician observer and the patient on his or her satisfaction. Forty-nine residents (51% interns, 55% general surgery residents) participated. Seventy per cent had no prior geriatrics education. Test scores significantly improved from pretest to posttest (12.9 ± 3.1 vs 13.78 ± 3.12, P = 0.01). The scores were consistently better on poly topics and consistently worse on end-of-life topics: pretest per cent correct: polypharmacy 60, end of life 46, P = 0.007; posttest percent correct: polypharmacy 63, end of life 49, P = 0.0014. By Pearson correlation, the pretest and posttest scores did not correlate with either the observer ( R = -0.16, P = 0.27 pre, R = -0.08, P = 0.59 post) or subscores ( R = -0.27, P = 0.11 pre, R = -0.13, P = 0.45 post), although the observer and subscore correlated with each other ( R = 0.35, P = 0.036). Performance was poor and did not correlate with better patient care by simulation. Other options for geriatric education need to be considered and evaluated.
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Affiliation(s)
- TherÈSe M. Duane
- Department of Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Lingbo Fan
- Department of Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Arline Bohannon
- Department of Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Jinfeng Han
- Department of Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Luke Wolfe
- Department of Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Julie Mayglothling
- Department of Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - James Whelan
- Department of Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Michael Aboutanos
- Department of Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Ajai Malhotra
- Department of Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Rao R. Ivatury
- Department of Surgery, Virginia Commonwealth University, Richmond, Virginia
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Weir AB, Brint JM. Hope is a verb: a course correction in delivering bad news. Am J Hosp Palliat Care 2011; 28:525-7. [PMID: 21482556 DOI: 10.1177/1049909111404550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Alva Bowen Weir
- University of Tennessee Health Science Center of Memphis, Memphis, USA.
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Abstract
Worldviews are sets of beliefs and assumptions that express how cultures interpret and explain their experience. Worldview has been a useful explanatory construct in the social science literature, but has been used less often in the context of human health. Reducing and ultimately eliminating the negative role that health care providers play in producing health disparities will require a cultural change. Here I posit that "worldview" is a critically important concept for health disparities education that overtime will serve to transform the culture of health care professionals toward a more self-reflective, humble, and open-minded posture.
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Affiliation(s)
- Jon C Tilburt
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA.
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Abstract
At the core of hospice remains the defining nature of mortals tending to other mortals facing diagnosed terminality. Such situations are pregnant with meanings. As mortals are subjective beings, social engagements become inundated with meaning differences. This alludes to the inescapable occurrence of collisions and conflicts in meaning. It would behoove us to make explicit the contention that exists in hospice care, given that death is the nonnegotiable outcome to be diversely faced by all involved persons whose lived approaches related to death issues may characteristically lack unanimity. Toward elucidating the inherently contentious nature of hospice care, the dynamical influence of external forces that overlie thanatological matters in society and the complex human dynamic in hospice care situations are discussed. Practice suggestions for hospice staff are offered.
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Kim JH, Choi YS. The Last Hours of Living: Practical Advice for Clinicians. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2009. [DOI: 10.5124/jkma.2009.52.7.697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jung Hyun Kim
- Department of Family Medicine, Cheongju Hana General Hospital, Korea.
| | - Youn Seon Choi
- Department of Family Medicine, Korea University College of Medicine, Korea.
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