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Bartlett MJ, Umoren R, Amory JH, Huynh T, Kim AJH, Stiffler AK, Mastroianni R, Ficco E, French H, Gray M. Measuring antenatal counseling skill with a milestone-based assessment tool: a validation study. BMC MEDICAL EDUCATION 2023; 23:325. [PMID: 37165398 PMCID: PMC10170031 DOI: 10.1186/s12909-023-04282-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 04/20/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Antenatal counseling for parents in the setting of expected preterm delivery is an important component of pediatric training. However, healthcare professionals receive a variable amount and quality of formal training. This study evaluated and discussed validity of a practical tool to assess antenatal counseling skills and provide evaluative feedback: the Antenatal Counseling Milestones Scale (ACoMS). METHODS Experts in antenatal counseling developed an anchored milestone-based tool to evaluate observable skills. Study participants with a range of antenatal counseling skills were recruited to participate in simulation of counseling sessions in person or via video with standardized patient actors presenting with preterm labor at 23 weeks' gestation. Two faculty observers scored each session independently using the ACoMS. Participants completed an ACoMS self-assessment, demographic, and feedback survey. Validity was measured with weighted kappas for inter-rater agreement, Kruskal-Wallis and Dunn's tests for milestone levels between degrees of expertise in counseling, and cronbach's alpha for item consistency. RESULTS Forty-two participants completed observed counseling sessions. Of the 17 items included in the tool, 15 items were statistically significant with scores scaling with level of training. A majority of elements had fair-moderate agreement between raters, and there was high internal consistency amongst all items. CONCLUSION This study demonstrates that the internal structure of the ACoMS rubric has greater than fair inter-rater reliability and high internal consistency amongst items. Content validity is supported by the scale's ability to discern level of training. Application of the ACoMS to clinical encounters is needed to determine utility in clinical practice.
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Affiliation(s)
| | - Rachel Umoren
- University of Washington School of Medicine, Seattle, 98105, USA
| | | | - Trang Huynh
- Oregon Health & Science University, Portland, USA
| | | | | | | | - Ellie Ficco
- University of Washington School of Medicine, Seattle, 98105, USA
| | | | - Megan Gray
- University of Washington School of Medicine, Seattle, 98105, USA
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2
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Scala M, Marchman VA, Dowtin LL, Givrad S, Nguyen T, Thomson A, Gao C, Sorrells K, Hall S. Evaluation of a course for neonatal fellows on providing psychosocial support to NICU families. PEC INNOVATION 2022; 1:100053. [PMID: 37213727 PMCID: PMC10194397 DOI: 10.1016/j.pecinn.2022.100053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 05/12/2022] [Accepted: 05/19/2022] [Indexed: 05/23/2023]
Abstract
Objectives Families in the Neonatal Intensive Care Unit (NICU) experience significant psychological distress. Fellowship training requires education on mental health issues. No standardized program exists. We evaluated the impact of an online course, combining research with family perspectives, on neonatology fellow knowledge and self-efficacy when emotionally supporting NICU families. Methods Fellows from 20 programs completed a course covering: (1) Parent Mental Health, (2) Infant Mental Health, (3) Communication, and (4) Comprehensive Mental Health (e.g., discharge, bereavement) with pre- and post-course knowledge and self-efficacy assessments. Results Fellows (n=91) completed the course and assessments. Pre-course knowledge was similar by year of training (1st: 66.9%; 2nd: 67.2%; 3rd: 67.4%). Mean knowledge and self-efficacy improved between pre- and post-course assessments regardless of training year or prior education for knowledge (d=1.2) (67.1% vs. 79.4%) and for self-efficacy (d=1.2) (4.7 vs 5.2 on 6-point Likert scale). Fellows who gained more knowledge had higher self-efficacy scores at post-test (r = .37). Conclusions Current neonatal fellowship training under-educates on mental health. An online course improved fellow knowledge and self-efficacy. Our course may be an exemplar for others creating similar curricula. Innovation An online course enriched by patient perspectives is an effective method of disseminating education around mental health.
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Affiliation(s)
- Melissa Scala
- Department of Pediatrics, Stanford University, Palo Alto, CA, USA
- Corresponding author at: Division of Neonatal and Developmental Medicine, Stanford University, MC5660, 453 Quarry Road, Palo Alto, CA 94304, USA.
| | | | | | - Soudabeh Givrad
- Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA
| | - Tuan Nguyen
- Department of Pediatrics, Stanford University, Palo Alto, CA, USA
| | - Alexa Thomson
- Human Biology, Stanford University, Stanford, CA, USA
| | - Courtney Gao
- Human Biology, Stanford University, Stanford, CA, USA
| | | | - Sue Hall
- St John’s Regional Medical Center (retired), Oxnard, CA, USA
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Wraight CL, Eickhoff JC, McAdams RM. Gaps in Palliative Care Education among Neonatology Fellowship Trainees. Palliat Med Rep 2021; 2:212-217. [PMID: 34927144 PMCID: PMC8675219 DOI: 10.1089/pmr.2021.0011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2021] [Indexed: 11/24/2022] Open
Abstract
Background: To provide proper care for infants at risk for death, neonatologists need expertise in many areas of palliative care. Although neonatology training programs have implemented a wide variety of palliative care educational programs, the impact of these programs on trainees' skills and effective communication regarding end-of-life issues remains unclear. Objective: To determine whether neonatology fellowship programs are providing formal palliative care education and assess whether this education is effective at increasing fellows' self-reported comfort with these important skills. Methods: An anonymous survey was sent to program directors (PDs) and fellows of ACGME accredited neonatology fellowship programs in the United States. Using a 5-point Likert scale, participants were asked about the palliative care education they received, and their comfort level with several key aspects of palliative care. Results: Twenty-four (26%) PDs and 66 (33%) fellows completed the survey. Fourteen PDs (58%) reported including palliative care education in their formal fellowship curriculum, whereas only 20 (30%) responding fellows reported receiving palliative care education. Of the responding fellows, most (80%) reported being uncomfortable or only somewhat comfortable with all assessed areas of palliative care. Fellows who received formal education were more comfortable than those without it in leading goals of care conversations (p = 0.001), breaking bad news (p = 0.048), discussing change in code status (p = 0.029), and grief and bereavement (p = 0.031). Conclusions: Most fellows report being uncomfortable or only somewhat comfortable with essential areas of palliative care. Formal palliative care education improves fellows' self-reported comfort with important aspects of end-of-life care. To promote a well-rounded neonatology fellowship curriculum, inclusion of formal palliative care education is recommended.
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Affiliation(s)
- Catherine Lydia Wraight
- Division of Neonatology, Department of Pediatrics, and University of Wisconsin, Madison, Wisconsin, USA
| | - Jens C Eickhoff
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, Wisconsin, USA
| | - Ryan M McAdams
- Division of Neonatology, Department of Pediatrics, and University of Wisconsin, Madison, Wisconsin, USA
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4
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Mendez MP, Patel H, Talan J, Doering M, Chiarchiaro J, Sternschein RM, Steinbach TC, O’Toole J, Sankari A, McCallister JW, Lee MM, Carlos WG, Lyons PG. Communication Training in Adult and Pediatric Critical Care Medicine. A Systematic Review. ATS Sch 2020; 1:316-330. [PMID: 33870298 PMCID: PMC8043309 DOI: 10.34197/ats-scholar.2019-0017re] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 05/12/2020] [Indexed: 12/05/2022] Open
Abstract
Background: Interpersonal and communication skills are essential for physicians practicing in critical care settings. Accordingly, demonstration of these skills has been a core competency of the Accreditation Council for Graduate Medical Education since 2014. However, current practices regarding communication skills training in adult and pediatric critical care fellowships are not well described. Objective: To describe the current state of communication curricula and training methods in adult and pediatric critical care training programs as demonstrated by the published literature. Methods: We performed a systematic review of the published literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Three authors reviewed a comprehensive set of databases and independently selected articles on the basis of a predefined set of inclusion and exclusion criteria. Data were independently extracted from the selected articles. Results: The 23 publications meeting inclusion criteria fell into the following study classifications: intervention (n = 15), cross-sectional survey (n = 5), and instrument validation (n = 3). Most interventional studies assessed short-term and self-reported outcomes (e.g., learner attitudes and perspectives) only. Fifteen of 22 publications represented pediatric subspecialty programs. Conclusion: Opportunities exist to evaluate the influence of communication training programs on important outcomes, including measured learner behavior and patient and family outcomes, and the durability of skill retention.
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Affiliation(s)
- Michael P. Mendez
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
- Division of Pulmonary Critical Care Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Harin Patel
- Division of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Jordan Talan
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University Langone Health, New York, New York
| | | | - Jared Chiarchiaro
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Rebecca M. Sternschein
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Trevor C. Steinbach
- Division of Pulmonary, Critical Care & Sleep Medicine, University of Washington, Seattle, Washington
| | - Jacqueline O’Toole
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Abdulghani Sankari
- John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan
- Division of Pulmonary Critical Care Medicine, Wayne State University, Detroit, Michigan
- Department of Medical Education, Ascension Providence Health System, Southfield, Michigan
| | - Jennifer W. McCallister
- Division of Pulmonary, Critical Care, and Sleep Medicine, Ohio State University College of Medicine, Columbus, Ohio
| | - May M. Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Southern California Keck School of Medicine, Los Angeles, California; and
| | - W. Graham Carlos
- Division of Pulmonary, Allergy, Critical Care, and Occupational Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Patrick G. Lyons
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, Missouri
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Paulsen K, Wu DS, Mehta AK. Primary Palliative Care Education for Trainees in U.S. Medical Residencies and Fellowships: A Scoping Review. J Palliat Med 2020; 24:354-375. [PMID: 32640863 DOI: 10.1089/jpm.2020.0293] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: The medical profession increasingly recognizes the growing need to educate nonpalliative physicians in palliative care. Objective: This study aims to provide a scoping review of the primary palliative care (PPC) education currently available to graduate medical trainees in primary and specialty tracks. Design: Studies of PPC interventions in U.S. residency or fellowship programs of all subspecialties published in English and listed on MEDLINE, CINAHL, and EMBASE through January 2020 were included. To meet admission criteria, studies had to describe the content, delivery methods, and evaluation instruments of a PPC educational intervention. Results: Of 233 eligible full texts, 85 studies were included for assessment, of which 66 were novel PPC educational interventions and 19 were standard education. Total number of publications evaluating PPC education increased from 8 (2000-2004) to 36 (2015-2019), across 11 residency and 10 fellowship specialties. Residency specialties representing the majority of publications were emergency medicine, general surgery, internal medicine, and pediatric/medicine-pediatrics. PPC content domains most taught in residencies were communication and symptom management; the primary delivery method was didactics, and the outcome assessed was attitudes. Fellowship specialties representing the majority of publications were pediatric subspecialties, nephrology, and oncology. The PPC content domain most taught in fellowships was communication; the primary delivery method was didactics and the outcome evaluated was attitudes. Conclusions: While PPC education has increased, it remains varied in content, delivery method, and intervention evaluations. Future studies should include more widespread evaluation of behavioral outcomes, longitudinal persistence of use, and clinical impact.
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Affiliation(s)
- Kate Paulsen
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - David S Wu
- Palliative Care Program, Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Ambereen K Mehta
- Palliative Care Program, Department of Medicine, University of California, Los Angeles Medical Center, Santa Monica, California, USA
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Meaningful Messages From Grief Workshop Participants: A Constructivist Grounded Theory Study. J Hosp Palliat Nurs 2020; 22:180-187. [PMID: 32168087 DOI: 10.1097/njh.0000000000000641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although there is an increased need for delivery of bereavement care, many health care providers in acute care hospital settings feel inadequately prepared to deliver quality grief support, have lack of time, and have inexperience in provision of bereavement care. As a result, although families would like health care providers to offer bereavement support, they are inadequately trained and susceptible to burnout, resulting in families not having their needs met. The purpose of this qualitative study was to uncover the social process occurring in a bereavement education workshop titled "How to Care, What to Say" offered to health care providers. The goal of the workshop was to improve delivery of care for the dying and their family by providing holistic care to the family before, during, and after the death of a loved one. Past grief workshop participants who cared for the bereaved were interviewed, and data were analyzed and synthesized using constructivist grounded theory. Individual interviews and focus group data revealed participants' perceptions, learnings, and potential integration of the workshop into practice. The overarching theory of providing bereavement care that emerged from the data is "a relational process of understanding knowledge, self-awareness, moral responsibilities, and advancing grief competencies of providing holistic grief support."
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Hall SL, Famuyide ME, Saxton SN, Moore TA, Mosher S, Sorrells K, Milford CA, Craig J. Improving Staff Knowledge and Attitudes Toward Providing Psychosocial Support to NICU Parents Through an Online Education Course. Adv Neonatal Care 2019; 19:490-499. [PMID: 31306236 PMCID: PMC6882527 DOI: 10.1097/anc.0000000000000649] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Provider-parent communication is a critical determinant of how neonatal intensive care unit (NICU) parents cope, yet staff feel inadequately trained in communication techniques; many parents are not satisfied with the support they receive from hospital providers. PURPOSE This study evaluated whether NICU staff would demonstrate improved knowledge and attitudes about providing psychosocial support to parents after taking an online course. METHODS After providing demographic information, staff at 2 NICUs took a 33-item survey both before and after taking a 7-module online course "Caring for Babies and Their Families," and again at 6-month follow-up. Scores (means ± standard deviation) from all time periods were compared and effect sizes calculated for each of the course modules. RESULTS NICU staff participants (n = 114) included nurses (88%), social workers (7%), physicians (4%), and occupational therapists (1%). NICU staff showed significant improvement in both knowledge and attitudes in all modules after taking the course, and improvements in all module subscores remained significant at the 6-month follow-up mark. Night staff and staff with less experience had lower pretest scores on several items, which improved on posttest. IMPLICATIONS FOR PRACTICE This course, developed by an interprofessional group that included graduate NICU parents, was highly effective in improving staff knowledge and attitudes regarding the provision of psychosocial support to NICU parents, and in eliminating differences related to shift worked and duration of work experience in the NICU. IMPLICATIONS FOR RESEARCH Future research should evaluate course efficacy across NICU disciplines beyond nursing, impact on staff performance, and whether parent satisfaction with care is improved.
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Affiliation(s)
- Sue L. Hall
- St John's Regional Medical Center, Oxnard, California (Dr Hall); Division of Neonatology, University of Mississippi Medical School, Jackson (Dr Famuyide); Departments of Pediatrics and Neonatology, Oregon Health & Science University, Portland (Dr Saxton); College of Nursing, University of Nebraska Medical Center, Omaha (Dr Moore); Patient+Family Care, Bend, Oregon (Ms Mosher); Preemie Parent Alliance, Jackson, Mississippi (Ms Sorrells); Cheryl Milford Consulting, Manhattan Beach, California (Ms Milford); and Brenau University School of Occupational Therapy, Gainesville, Georgia (Dr Craig)
| | - Mobolaji E. Famuyide
- St John's Regional Medical Center, Oxnard, California (Dr Hall); Division of Neonatology, University of Mississippi Medical School, Jackson (Dr Famuyide); Departments of Pediatrics and Neonatology, Oregon Health & Science University, Portland (Dr Saxton); College of Nursing, University of Nebraska Medical Center, Omaha (Dr Moore); Patient+Family Care, Bend, Oregon (Ms Mosher); Preemie Parent Alliance, Jackson, Mississippi (Ms Sorrells); Cheryl Milford Consulting, Manhattan Beach, California (Ms Milford); and Brenau University School of Occupational Therapy, Gainesville, Georgia (Dr Craig)
| | - Sage N. Saxton
- St John's Regional Medical Center, Oxnard, California (Dr Hall); Division of Neonatology, University of Mississippi Medical School, Jackson (Dr Famuyide); Departments of Pediatrics and Neonatology, Oregon Health & Science University, Portland (Dr Saxton); College of Nursing, University of Nebraska Medical Center, Omaha (Dr Moore); Patient+Family Care, Bend, Oregon (Ms Mosher); Preemie Parent Alliance, Jackson, Mississippi (Ms Sorrells); Cheryl Milford Consulting, Manhattan Beach, California (Ms Milford); and Brenau University School of Occupational Therapy, Gainesville, Georgia (Dr Craig)
| | - Tiffany A. Moore
- St John's Regional Medical Center, Oxnard, California (Dr Hall); Division of Neonatology, University of Mississippi Medical School, Jackson (Dr Famuyide); Departments of Pediatrics and Neonatology, Oregon Health & Science University, Portland (Dr Saxton); College of Nursing, University of Nebraska Medical Center, Omaha (Dr Moore); Patient+Family Care, Bend, Oregon (Ms Mosher); Preemie Parent Alliance, Jackson, Mississippi (Ms Sorrells); Cheryl Milford Consulting, Manhattan Beach, California (Ms Milford); and Brenau University School of Occupational Therapy, Gainesville, Georgia (Dr Craig)
| | - Sara Mosher
- St John's Regional Medical Center, Oxnard, California (Dr Hall); Division of Neonatology, University of Mississippi Medical School, Jackson (Dr Famuyide); Departments of Pediatrics and Neonatology, Oregon Health & Science University, Portland (Dr Saxton); College of Nursing, University of Nebraska Medical Center, Omaha (Dr Moore); Patient+Family Care, Bend, Oregon (Ms Mosher); Preemie Parent Alliance, Jackson, Mississippi (Ms Sorrells); Cheryl Milford Consulting, Manhattan Beach, California (Ms Milford); and Brenau University School of Occupational Therapy, Gainesville, Georgia (Dr Craig)
| | - Keira Sorrells
- St John's Regional Medical Center, Oxnard, California (Dr Hall); Division of Neonatology, University of Mississippi Medical School, Jackson (Dr Famuyide); Departments of Pediatrics and Neonatology, Oregon Health & Science University, Portland (Dr Saxton); College of Nursing, University of Nebraska Medical Center, Omaha (Dr Moore); Patient+Family Care, Bend, Oregon (Ms Mosher); Preemie Parent Alliance, Jackson, Mississippi (Ms Sorrells); Cheryl Milford Consulting, Manhattan Beach, California (Ms Milford); and Brenau University School of Occupational Therapy, Gainesville, Georgia (Dr Craig)
| | - Cheryl A. Milford
- St John's Regional Medical Center, Oxnard, California (Dr Hall); Division of Neonatology, University of Mississippi Medical School, Jackson (Dr Famuyide); Departments of Pediatrics and Neonatology, Oregon Health & Science University, Portland (Dr Saxton); College of Nursing, University of Nebraska Medical Center, Omaha (Dr Moore); Patient+Family Care, Bend, Oregon (Ms Mosher); Preemie Parent Alliance, Jackson, Mississippi (Ms Sorrells); Cheryl Milford Consulting, Manhattan Beach, California (Ms Milford); and Brenau University School of Occupational Therapy, Gainesville, Georgia (Dr Craig)
| | - Jenene Craig
- St John's Regional Medical Center, Oxnard, California (Dr Hall); Division of Neonatology, University of Mississippi Medical School, Jackson (Dr Famuyide); Departments of Pediatrics and Neonatology, Oregon Health & Science University, Portland (Dr Saxton); College of Nursing, University of Nebraska Medical Center, Omaha (Dr Moore); Patient+Family Care, Bend, Oregon (Ms Mosher); Preemie Parent Alliance, Jackson, Mississippi (Ms Sorrells); Cheryl Milford Consulting, Manhattan Beach, California (Ms Milford); and Brenau University School of Occupational Therapy, Gainesville, Georgia (Dr Craig)
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Turrillas P, Teixeira MJ, Maddocks M. A Systematic Review of Training in Symptom Management in Palliative Care Within Postgraduate Medical Curriculums. J Pain Symptom Manage 2019; 57:156-170.e4. [PMID: 30287198 DOI: 10.1016/j.jpainsymman.2018.09.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 09/18/2018] [Accepted: 09/20/2018] [Indexed: 11/23/2022]
Abstract
CONTEXT Symptom management is a priority area within palliative care core competencies for generalist providers. Although several educational initiatives exist, a comprehensive evidence synthesis on the effectiveness of symptom management training on trainees' learning and patient-reported outcomes is lacking. OBJECTIVES The objective of this study was to determine the effectiveness of training in symptom management in palliative care providers in nonpalliative specialties. METHODS This is a systematic review following Best Evidence Medical Education methods from searches of MEDLINE, EMBASE, ERIC, CINAHL, PsycINFO, Cochrane database of systematic, Clinical Trials.gov, and ISRCTN databases to September 2017. Prospective controlled studies testing the impact of symptom management educational interventions on physicians in training in nonpalliative specialties were included. Data were summarized narratively, grouped by curriculum description, and effectiveness on trainees' learning or patient-reported outcomes. RESULTS Of 5062 records identified, six studies met the inclusion criteria: two randomized controlled trials and four quasi-experimental. Pain management and use of opioids and their side effects were most frequently covered. Clinical decision support tools, Web-based teaching, palliative care rotation, and mixed educational methods were used. Most studies used self-reported, original, or modified evaluation instruments, although psychometric properties were seldom reported. Despite methodological considerations, all educational methods improved trainees' learning outcomes. However, the effects on trainees' behavior and patient-related outcomes were not evaluated. CONCLUSION Current educational training programs in symptom management appear to improve trainees' comfort, preparedness, and knowledge in assessing and managing patients' symptoms at the end of life. More rigorous research to evaluate the impact of this training on residents and organizational performance is now required.
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Affiliation(s)
- Pamela Turrillas
- Department of Palliative Care, Policy, and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK.
| | - Maria Joao Teixeira
- Department of Palliative Care, Policy, and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | - Matthew Maddocks
- Department of Palliative Care, Policy, and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
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9
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Pediatric Palliative Care in Infants and Neonates. CHILDREN-BASEL 2018; 5:children5020021. [PMID: 29414846 PMCID: PMC5835990 DOI: 10.3390/children5020021] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 01/24/2018] [Accepted: 02/01/2018] [Indexed: 01/26/2023]
Abstract
The application of palliative and hospice care to newborns in the neonatal intensive care unit (NICU) has been evident for over 30 years. This article addresses the history, current considerations, and anticipated future needs for palliative and hospice care in the NICU, and is based on recent literature review. Neonatologists have long managed the entirety of many newborns' short lives, given the relatively high mortality rates associated with prematurity and birth defects, but their ability or willingness to comprehensively address of the continuum of interdisciplinary palliative, end of life, and bereavement care has varied widely. While neonatology service capacity has grown worldwide during this time, so has attention to pediatric palliative care generally, and neonatal-perinatal palliative care specifically. Improvements have occurred in family-centered care, communication, pain assessment and management, and bereavement. There remains a need to integrate palliative care with intensive care rather than await its application solely at the terminal phase of a young infant's life-when s/he is imminently dying. Future considerations for applying neonatal palliative care include its integration into fetal diagnostic management, the developing era of genomic medicine, and expanding research into palliative care models and practices in the NICU.
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10
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Brock KE, Cohen HJ, Sourkes BM, Good JJ, Halamek LP. Training Pediatric Fellows in Palliative Care: A Pilot Comparison of Simulation Training and Didactic Education. J Palliat Med 2017; 20:1074-1084. [PMID: 28436742 DOI: 10.1089/jpm.2016.0556] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pediatric fellows receive little palliative care (PC) education and have few opportunities to practice communication skills. OBJECTIVE In this pilot study, we assessed (1) the relative effectiveness of simulation-based versus didactic education, (2) communication skill retention, and (3) effect on PC consultation rates. DESIGN Thirty-five pediatric fellows in cardiology, critical care, hematology/oncology, and neonatology at two institutions enrolled: 17 in the intervention (simulation-based) group (single institution) and 18 in the control (didactic education) group (second institution). Intervention group participants participated in a two-day program over three months (three simulations and videotaped PC panel). Control group participants received written education designed to be similar in content and time. MEASUREMENTS (1) Self-assessment questionnaires were completed at baseline, post-intervention and three months; mean between-group differences for each outcome measure were assessed. (2) External reviewers rated simulation-group encounters on nine communication domains. Within-group changes over time were assessed. (3) The simulation-based site's PC consultations were compared in the six months pre- and post-intervention. RESULTS Compared to the control group, participants in the intervention group improved in self-efficacy (p = 0.003) and perceived adequacy of medical education (p < 0.001), but not knowledge (p = 0.20). Reviewers noted nonsustained improvement in four domains: relationship building (p = 0.01), opening discussion (p = 0.03), gathering information (p = 0.01), and communicating accurate information (p = 0.04). PC consultation rate increased 64%, an improvement when normalized to average daily census (p = 0.04). CONCLUSIONS This simulation-based curriculum is an effective method for improving PC comfort, education, and consults. More frequent practice is likely needed to lead to sustained improvements in communication competence.
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Affiliation(s)
- Katharine E Brock
- 1 Division of Pediatric Hematology/Oncology, Emory University , Atlanta, Georgia .,2 Aflac Cancer & Blood Disorders Center , Children's Healthcare of Atlanta, Atlanta, Georgia .,3 Pediatric Palliative Care, Children's Healthcare of Atlanta , Atlanta, Georgia
| | - Harvey J Cohen
- 4 Department of Pediatrics, Stanford University , Stanford, California.,5 Division of Hematology/Oncology, Stanford University , Stanford, California
| | - Barbara M Sourkes
- 4 Department of Pediatrics, Stanford University , Stanford, California.,6 Division of Critical Care Medicine, Stanford University , Stanford, California
| | - Julie J Good
- 4 Department of Pediatrics, Stanford University , Stanford, California.,7 Division of Anesthesiology, Perioperative and Pain Medicine, Stanford University , Stanford, California
| | - Louis P Halamek
- 4 Department of Pediatrics, Stanford University , Stanford, California.,8 Division of Neonatal and Developmental Medicine, Stanford University , Stanford, California.,9 Center for Advanced Pediatric and Perinatal Education, Stanford University , Stanford, California
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11
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Abstract
Neonatologists receive highly varied and largely inadequate training to acquire and maintain communication and palliative care skills. Neonatology fellows often need to give distressing news to families and frequently face unique communication challenges. While several approaches to teaching these skills exist, practice opportunities through simulation and role play will likely provide the most effective learning.
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Affiliation(s)
- Natalia Henner
- Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E, Chicago Ave, Box 36, Chicago, IL 60611-2605.
| | - Renee D Boss
- Division of Neonatology, Johns Hopkins School of Medicine, Berman Institute of Bioethics, Baltimore, MD
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12
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Abstract
Ethics and professionalism education has become increasingly recognized as important and incorporated into graduate medical education. However, such education has remained largely unstructured and understudied in neonatology. Neonatal-perinatal fellowship training programs have generally grappled with how best to teach and assess ethics and professionalism knowledge, skills, and behavior in clinical practice, particularly in light of accreditation requirements, milestones, and competencies. This article reviews currently available teaching methods, pedagogy, and resources in medical ethics, professionalism, and communication, as well as assessment strategies and tools, to help medical educators and practicing clinicians ensure trainees achieve and maintain competency. The need for consensus and future research in these domains is also highlighted.
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Affiliation(s)
- Christy L Cummings
- Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Hunnewell 437, Boston, MA.
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