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Shah K, Janssen A, Donnelly C, Shaw T. Digital Educational Interventions for the Development of Advanced Care Planning Skills for Medical Practitioners: A Scoping Review. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2022; 43:181-187. [PMID: 36215159 DOI: 10.1097/ceh.0000000000000460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Medical practitioners are important facilitators of advanced care planning but are often reluctant to engage in these conversations with patients and their families. Barriers to participation can be addressed through medical education for medical practitioners. INTRODUCTION The primary objective was to examine the extent to which digital educational interventions are used to foster advanced care planning skills. Secondary objectives include understanding the acceptability of these interventions and whether electronic health records can be used to personalize learning. METHODS Online databases were used to identify relevant articles published from 2008 to 2021. Nine articles which evaluated the impact of digital learning for medical practitioners were selected. Studies eligible for inclusion in the review assessed changes in knowledge, attitudes, and practice regarding skills used in advanced care planning. RESULTS All publications used a pre-post study design with education delivered solely online. Only three studies focused on completing advance care plans or directives (33%). All but two studies recorded improvements in knowledge and/or attitudes toward planning (78%) while three studies recorded improvements in clinical practice (33%). The review suggests prior clinical or personal experiences could be used to personalize education. DISCUSSION The literature revealed that using digital education to develop advanced care planning skills is relatively unexplored despite the ability of this type of learning to improve professional knowledge and confidence. Digital devices can also improve access to relevant information at the point-of-care. Personalized interventions that incorporate prior clinical experiences, potentially extracted from health records, could be used to optimize outcomes.
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Affiliation(s)
- Kavisha Shah
- Ms. Shah: Research Assistant, The University of Sydney, Faculty of Medicine and Health, Sydney, Australia, and Sydney West Translational Cancer Research Centre, Sydney, Australia. Dr. Janssen: Senior Research Fellow, the University of Sydney, Faculty of Medicine and Health, Sydney, Australia. Mrs Donnelly: Senior Research Officer, PhD Candidate, The University of Sydney, Faculty of Medicine and Health, Sydney, Australia, and Sydney West Translational Cancer Research Centre, Sydney, Australia. Prof. Shaw: Director of Research in Implementation Science and Health (PhD, BSc), the University of Sydney, Faculty of Medicine and Health, Sydney, Australia
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Cardinale M, Kumapley G, Wong C, Kuc ME, Beagin E. Impact of a Nurse-Driven Opioid Titration Protocol on Quality of Orders at End of Life. J Hosp Palliat Nurs 2021; 23:78-83. [PMID: 33252423 DOI: 10.1097/njh.0000000000000716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
At our community teaching hospital, orders for end of life often lacked instructions to titrate opioids based on evidence-based principles and failed to address nonpain symptoms. An order set and a nursing-driven opioid titration protocol were implemented in August 2016 after extensive education. The purpose of this retrospective preintervention and postintervention study was to evaluate the impact of this intervention on the quality of end-of-life orders. We evaluated 69 patients with terminal illness receiving morphine infusions. After implementation, more morphine infusion orders included an as-needed bolus dose with an objective indication and appropriate instructions on when and how to titrate the infusion compared with before the intervention (94.6% vs 18.8%, P < .0001). Morphine infusion orders were also significantly more likely to include a maximum dose (P = .041) and an initial bolus dose (P < .0001). In addition, prescribers were more likely to order additional medications to manage nausea/vomiting, constipation, anxiety, or pain using a nonopioid (P < .05 for all). In this study, implementation of a standardized opioid titration protocol and symptom management order set led to an improvement in the quality of morphine infusion orders for pain management at the end of life and increased the use of medications to manage nonpain symptoms in dying patients.
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Williams BR, Bailey FA, Goode PS, Kvale EA, Slay LA, Bakitas MA, Burgio KL. "Online Training Is Great but Human Interaction Is Better": Training Preferences of VA Interdisciplinary Palliative Care Consult Teams. Am J Hosp Palliat Care 2020; 37:800-808. [PMID: 32122166 DOI: 10.1177/1049909120907599] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A growing body of research has examined modalities for delivering palliative care education; however, we know little about education and training preferences of VA interdisciplinary Palliative Care Consult Teams (PCCT). In the BEACON II study, we explored training preferences of PCCTs from 46 Veterans Affairs Medical Centers (VAMCs) participating in either a multisite webinar or a small group, in-person workshop. We interviewed participants by telephone seven to eight month post-training. In all, 75.9% preferred in-person education and training, including 78.9% of workshop participants and 73.1% of webinar participants. Respondents described in-person training as fostering learning through the following processes: (1) active engagement and focus, (2) interaction and networking, (3) meaning-making and relevance, and (4) reciprocity and commitment. Although it is not possible for Web-based palliative care education programs to replicate all aspects of the in-person learning experience, building experiential, interactive, meaningful, and reciprocal components into Web-based education may help shift preferences and make interdisciplinary team-based palliative care education accessible to a larger audience.
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Affiliation(s)
- Beverly Rosa Williams
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL and Atlanta, GA, USA.,Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - F Amos Bailey
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL and Atlanta, GA, USA.,Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Medicine, Denver Health Medical Center, University of Colorado Denver, Denver, CO, USA
| | - Patricia S Goode
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL and Atlanta, GA, USA.,Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth A Kvale
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL and Atlanta, GA, USA.,Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Medicine, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Laurie A Slay
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL and Atlanta, GA, USA.,Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marie A Bakitas
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL and Atlanta, GA, USA.,Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kathryn L Burgio
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL and Atlanta, GA, USA.,Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Douglas SL, Daly BJ, Meropol NJ, Lipson AR. Patient-physician discordance in goals of care for patients with advanced cancer. ACTA ACUST UNITED AC 2019; 26:370-379. [PMID: 31896935 DOI: 10.3747/co.26.5431] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background Shared decision-making at end of life (eol) requires discussions about goals of care and prioritization of length of life compared with quality of life. The purpose of the present study was to describe patient and oncologist discordance with respect to goals of care and to explore possible predictors of discordance. Methods Patients with metastatic cancer and their oncologists completed an interview at study enrolment and every 3 months thereafter until the death of the patient or the end of the study period (15 months). All interviewees used a 100-point visual analog scale to represent their current goals of care, with quality of life (scored as 0) and survival (scored as 100) serving as anchors. Discordance was defined as an absolute difference between patient and oncologist goals of care of 40 points or more. Results The study enrolled 378 patients and 11 oncologists. At baseline, 24% discordance was observed, and for patients who survived, discordance was 24% at their last interview. For patients who died, discordance was 28% at the last interview before death, with discordance having been 70% at enrolment. Dissatisfaction with eol care was reported by 23% of the caregivers for patients with discordance at baseline and by 8% of the caregivers for patients who had no discordance (p = 0.049; ϕ = 0.20). Conclusions The data indicate the presence of significant ongoing oncologist-patient discordance with respect to goals of care. Early use of a simple visual analog scale to assess goals of care can inform the oncologist about the patient's goals and lead to delivery of care that is aligned with patient goals.
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Affiliation(s)
- S L Douglas
- Case Comprehensive Cancer Center, Cleveland, OH.,Case Western Reserve University, Cleveland, OH
| | - B J Daly
- Flatiron Health, an independent subsidiary of the Roche Group, New York, NY, U.S.A.,Case Comprehensive Cancer Center, Cleveland, OH.,Case Western Reserve University, Cleveland, OH
| | - N J Meropol
- Case Comprehensive Cancer Center, Cleveland, OH.,Case Western Reserve University, Cleveland, OH.,University Hospitals Cleveland Medical Center, Cleveland, OH.,Flatiron Health, an independent subsidiary of the Roche Group, New York, NY, U.S.A
| | - A R Lipson
- Case Comprehensive Cancer Center, Cleveland, OH
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Pruskowski J, Patel R, Brazeau G. The Need for Palliative Care in Pharmacy Education. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2019; 83:7410. [PMID: 31333268 PMCID: PMC6630864 DOI: 10.5688/ajpe7410] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 02/28/2019] [Indexed: 06/10/2023]
Abstract
There is a growing need for palliative care pharmacists in the United States. There is also a gap in the education of palliative care for pharmacy students. To address both, pharmacy schools must develop and disseminate palliative care-focused experiences, including traditional didactic lectures, problem-based learning, interactive skills, laboratory- and web-based experiences. This commentary presents the need for palliative care-focused experiences in the Doctor of Pharmacy (PharmD) degree program, and how schools can take smaller steps to tackle this issue.
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Affiliation(s)
| | - Ravi Patel
- University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
| | - Gayle Brazeau
- Marshall University, Huntington, West Virginia
- Editor, American Journal of Pharmaceutical Education, Arlington, Virginia
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Bergman J, Laviana AA. Opportunities to maximize value with integrated palliative care. J Multidiscip Healthc 2016; 9:219-26. [PMID: 27226721 PMCID: PMC4863682 DOI: 10.2147/jmdh.s90822] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Palliative care involves aggressively addressing and treating psychosocial, spiritual, religious, and family concerns, as well as considering the overall psychosocial structures supporting a patient. The concept of integrated palliative care removes the either/or decision a patient needs to make: they need not decide if they want either aggressive chemotherapy from their oncologist or symptom-guided palliative care but rather they can be comanaged by several clinicians, including a palliative care clinician, to maximize the benefit to them. One common misconception about palliative care, and supportive care in general, is that it amounts to “doing nothing” or “giving up” on aggressive treatments for patients. Rather, palliative care involves very aggressive care, targeted at patient symptoms, quality-of-life, psychosocial needs, family needs, and others. Integrating palliative care into the care plan for individuals with advanced diseases does not necessarily imply that a patient must forego other treatment options, including those aimed at a cure, prolonging of life, or palliation. Implementing interventions to understand patient preferences and to ensure those preferences are addressed, including preferences related to palliative and supportive care, is vital in improving the patient-centeredness and value of surgical care. Given our aging population and the disproportionate cost of end-of-life care, this holds great hope in bending the cost curve of health care spending, ensuring patient-centeredness, and improving quality and value of care. Level 1 evidence supports this model, and it has been achieved in several settings; the next necessary step is to disseminate such models more broadly.
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Affiliation(s)
- Jonathan Bergman
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Veterans Health Affairs-Greater Los Angeles, Los Angeles, CA, USA
| | - Aaron A Laviana
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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