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Miles A, Brady A, Friary P, Sekula J, Wallis C, Jackson B. Implementing an interprofessional palliative care education program to speech-language therapy and dietetic students. J Interprof Care 2023; 37:964-973. [PMID: 37161383 DOI: 10.1080/13561820.2023.2203731] [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: 10/13/2022] [Revised: 03/14/2023] [Accepted: 04/06/2023] [Indexed: 05/11/2023]
Abstract
Palliative care education for allied health professionals has received minimal research attention. This longitudinal study followed the development of an education program for speech-language therapy (SLT) and dietetic (DT) students. The project comprised three stages. In Stage I, consenting SLT and DT graduates (n = 9) were interviewed 6 months after graduation exploring preparedness for working in palliative care. Interviews were transcribed, and topics were extracted through content analysis. In Stage II, a new palliative care curriculum was developed using the extant literature and gaps reported in Stage I. In Stage III, we implemented and evaluated the new curriculum. Students were surveyed before (n = 68) and after (n = 42) the new program and at 6-month post-graduation (n = 15) to capture student-reported changes in knowledge and confidence in palliative care. In Stage I, 10 topics were developed covering knowledge, roles, team, family-focused care, and feelings. In Stage II, a hybrid program was developed including e-learning modules, didactic lectures, and a simulated learning experience. In Stage III, student feedback demonstrated positive shifts in knowledge and confidence ratings from medians 3-6 to 5-8 (1 = none; 10 = excellent) across all domains. Gains in knowledge and confidence were consistently higher at 6-month post-graduation for final survey respondents. Mixed modality interprofessional palliative care education for allied health professionals has merit in improving knowledge, confidence, and perceived preparedness for practice.
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Affiliation(s)
- Anna Miles
- Speech Science, School of Psychology, Grafton Campus, The University of Auckland, Auckland, New Zealand
| | - Alana Brady
- Speech Science, School of Psychology, Grafton Campus, The University of Auckland, Auckland, New Zealand
| | - Philippa Friary
- Speech Science, School of Psychology, Grafton Campus, The University of Auckland, Auckland, New Zealand
| | - Julia Sekula
- Nutrition and Dietetics, The University of Auckland, Auckland, New Zealand
| | - Clare Wallis
- Nutrition and Dietetics, The University of Auckland, Auckland, New Zealand
| | - Bianca Jackson
- Speech Science, School of Psychology, Grafton Campus, The University of Auckland, Auckland, New Zealand
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Sachidanandan G, Sud A. From Two Dimensions to Multidimensions: A Mechanistic Model to Support Deliberate CPD Development, Coordination, and Evaluation. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023:00005141-990000000-00099. [PMID: 37782259 DOI: 10.1097/ceh.0000000000000527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
INTRODUCTION The effectiveness of continuing professional development as an intervention to improve health professional behavior and patient health is variable and contentious. To clarify the causal relationships underlying program outcomes and facilitate a necessary shift from outcomes-only-based approaches to outcome-based and theory-based approaches in program development and evaluation, we developed a model of mechanisms mapped to relevant outcomes. METHODS Mechanisms identified in a prior realist synthesis of opioid agonist therapy continuing professional development programs were iteratively tested and refined using purposive and opportunistic sampling and realist approaches against two systematic reviews of programs in analgesic prescribing and palliative care. Further testing involved practical application within programs in sustainable health care and pain management. RESULTS Ninety reports on 75 programs and practical application to multiple additional programs informed the final model consisting of five distinct mechanisms: motivation transformation, expert influence, confidence development, self-efficacy facilitation, and community of practice expansion. The mechanisms and related analysis emphasize that continuing professional development is heterogeneous, complex, and context dependent. DISCUSSION Shifting toward outcome-based and theory-based approaches facilitates further conceptual shifts at intraprogram and interprogram and interintervention levels toward more deliberate program development and evaluation, increased program complementarity and subsequent collaboration. It clarifies opportunities for intercalation of continuing professional development with other intervention sciences. The model presents a resource for practitioners, researchers, and policymakers to advance continuing professional development planning, coordination, and evaluation.
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Affiliation(s)
- Grahanya Sachidanandan
- Ms. Sachidanandan: Medical Student, Temerty Faculty of Medicine, University of Toronto. Dr. Sud: Research Chair, Primary Care & Population Health Systems, Humber River Hospital, and Assistant Professor, Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto
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Flinterman LE, González-González AI, Seils L, Bes J, Ballester M, Bañeres J, Dan S, Domagala A, Dubas-Jakóbczyk K, Likic R, Kroezen M, Batenburg R. Characteristics of Medical Deserts and Approaches to Mitigate Their Health Workforce Issues: A Scoping Review of Empirical Studies in Western Countries. Int J Health Policy Manag 2023; 12:7454. [PMID: 38618823 PMCID: PMC10590222 DOI: 10.34172/ijhpm.2023.7454] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 05/30/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Medical deserts are considered a problematic issue for many Western countries which try to employ multitude of policies and initiatives to achieve a better distribution of their health workforce (HWF). The aim of this study was to systematically map research and provide an overview of definitions, characteristics, contributing factors and approaches to mitigate medical deserts within the European Union (EU)-funded project "ROUTE-HWF" (a Roadmap OUT of mEdical deserts into supportive Health WorkForce initiatives and policies). METHODS We performed a scoping review to identify knowledge clusters/research gaps in the field of medical deserts focusing on HWF issues. Six databases were searched till June 2021. Studies reporting primary research from Western countries on definitions, characteristics, contributing factors, and approaches were included. Two independent reviewers assessed studies for eligibility, extracted data and clustered studies according to the four defined outcomes. RESULTS Two-hundred and forty studies were included (n=116, 48% Australia/New Zealand; n=105, 44% North America; n=20, 8% Europe). All used observational designs except for five quasi-experimental studies. Studies provided definitions (n=171, 71%), characteristics (n=95, 40%), contributing factors (n=112, 47%), and approaches to mitigate medical deserts (n=87, 36%). Most medical deserts were defined by the density of the population in an area. Contributing factors to HWF issues in medical deserts consisted in work-related (n=55, 23%) and lifestyle-related factors (n=33, 14%) of the HWF as well as sociodemographic characteristics (n=79, 33%). Approaches to mitigate them focused on training adapted to the scope of rural practice (n=67, 28%), HWF distribution (n=3, 1%), support/infrastructure (n=8, 3%) and innovative models of care (n=7, 3%). CONCLUSION Our study provides the first scoping review that presents and categorizes definitions, characteristics, contributing factors, and approaches to mitigate HWF issues in medical deserts. We identified gaps such as the scarcity of longitudinal studies to investigate the impact of factors contributing to medical deserts, and interventional studies to evaluate the effectiveness of approaches to mitigate HWF issues.
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Affiliation(s)
- Linda E. Flinterman
- Health Workforce and Organization Studies, Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | | | - Laura Seils
- Avedis Donabedian Research Institute – UAB, Madrid, Spain
| | - Julia Bes
- Health Workforce and Organization Studies, Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | | | | | - Sorin Dan
- Innovation and Entrepreneurship InnoLab, University of Vaasa, Vaasa, Finland
| | - Alicja Domagala
- Department of Health Policy and Management, Institute of Public Health, Jagiellonian University, Krakow, Poland
| | - Katarzyna Dubas-Jakóbczyk
- Department of Health Economics and Social Security, Institute of Public Health, Jagiellonian University, Krakow, Poland
| | - Robert Likic
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Marieke Kroezen
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Ronald Batenburg
- Health Workforce and Organization Studies, Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
- Department of Sociology, Radboud University, Nijmegen, The Netherlands
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Tsao L, Kwete XJ, Slater SE, Doyle KP, Cuong DD, Khanh QT, Mauer R, Thy DNM, Thinh DHQ, Tuan TD, Van Dung D, Khue LN, Krakauer EL. Effect of Training on Physicians' Palliative Care-Related Knowledge and Attitudes in Vietnam. J Pain Symptom Manage 2023; 66:146-159. [PMID: 37088114 DOI: 10.1016/j.jpainsymman.2023.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/21/2023] [Accepted: 04/16/2023] [Indexed: 04/25/2023]
Abstract
CONTEXT Palliative care remains largely inaccessible in low- and middle-income countries (LMICs), and efforts to increase access are impeded by lack of training of proven effectiveness for physicians. OBJECTIVES To measure the effectiveness of palliative care training for Vietnamese physicians. METHODS The palliative care-related knowledge, attitudes, and self-assessment of Vietnamese physicians were studied prior to a basic course in palliative care (baseline), just after the physicians completed the course (post), and 6-18 months later (follow-up). RESULTS The self-assessment scores and knowledge scores increased significantly from baseline to post and decreased significantly from post to follow-up, but the follow-up scores remained significantly higher than baseline. There were significant interactions between changes over time of the knowledge scores and baseline age, degree, years of graduation, training, type of work, and whether participants had ever prescribed morphine for pain. Medically appropriate attitudes increased significantly from baseline to post and did not decrease significantly from post to follow-up. CONCLUSION Our basic palliative care course in Vietnam resulted in significant and enduring improvements among physicians in palliative care-related knowledge, attitudes, and self-assessed competence. To respond to the enormous unmet need for palliative care in LMICs, primary care providers and physician-specialists in many fields, among others, should receive palliative care training of proven effectiveness, receive ongoing mentoring or refresher training, and be given the responsibility and opportunity to practice what they learn.
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Affiliation(s)
- Lulu Tsao
- Harvard Medical School (L.T.), Boston, Massachusetts, USA; Department of Medicine, School of Medicine, University of California (L.T.), San Fransisco, california, USA
| | - Xiaoxiao J Kwete
- Health Systems Group, Harvard School of Public Health (X.J.K.), Boston, Massachusetts, USA
| | - Sarah E Slater
- Department of Medical Oncology, Dana Farber Cancer Institute (S.E.S.), Boston, Massachusetts, USA; Department of Medicine, Harvard Medical School (S.E.S., K.P.D., E.L.K.), Boston, Massachusetts, USA
| | - Kathleen P Doyle
- Department of Medicine, Harvard Medical School (S.E.S., K.P.D., E.L.K.), Boston, Massachusetts, USA; Division of Palliative Care & Geriatric Medicine, Massachusetts General Hospital (E.L.K.), Boston, Massachusetts, USA
| | - Do Duy Cuong
- Department of Infectious Disease, Bach Mai National Hospital (D.D.C.), Hanoi, Vietnam
| | - Quach T Khanh
- Department of Infectious Disease, Bach Mai National Hospital (D.D.C.), Hanoi, Vietnam; Department of Palliative Care, Ho Chi Minh City Oncology Hospital (Q.T.K., D.H.Q.T.), Ho Chi Minh City, Vietnam
| | - Rie Mauer
- Department of Medicine, Brigham & Women's Hospital (R.M.), Boston, Massachusetts, USA
| | - Dang Ngoc Minh Thy
- Department of Medicine, St. Elizabeth Hospital (D.N.M.T.), Boston, Massachusetts, USA
| | - Dang Huy Quoc Thinh
- Department of Radiation Oncology, Ho Chi Minh City Oncology Hospital (Q.T.K., D.H.Q.T.), Ho Chi Minh City, Vietnam; Department of Palliative Care, Ho Chi Minh City Oncology Hospital (Q.T.K., D.H.Q.T.), Ho Chi Minh City, Vietnam
| | - Tran Diep Tuan
- Department of Pediatrics, University of Medicine and Pharmacy at Ho Chi Minh City (T.D.T.), Ho Chi Minh City, Vietnam
| | - Do Van Dung
- Department of Public Health, University of Medicine and Pharmacy (D.V.D.), Ho Chi Minh City, Vietnam
| | - Luong Ngoc Khue
- Administration of Medical Services, Ministry of Health of Vietnam (L.N.K.), Hanoi, Vietnam
| | - Eric L Krakauer
- Harvard Medical School (L.T.), Boston, Massachusetts, USA; Department of Medicine, Harvard Medical School (S.E.S., K.P.D., E.L.K.), Boston, Massachusetts, USA; Division of Palliative Care & Geriatric Medicine, Massachusetts General Hospital (E.L.K.), Boston, Massachusetts, USA; Department of Palliative Care, University of Medicine and Pharmacy (E.L.K.), Ho Chi Minh City, Vietnam.
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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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Predictors of At-Home Death for Cancer Patients in Rural Clinics in Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312703. [PMID: 34886428 PMCID: PMC8656844 DOI: 10.3390/ijerph182312703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND The prediction of at-home deaths has become an important topic in rural areas of Japan with an advanced aging society. However, there are no well-established predictors to explain how these factors influence intention. This study aims to investigate the possible predictors of at-home death for cancer patients in rural clinics in Japan. METHODS This is a nationwide cross-sectional survey. A self-administered questionnaire was sent to 493 rural clinics in Japan. The main outcome was the realization of at-home deaths for cancer patients. RESULTS Among the 264 clinics (54%) that responded to the survey, there were 194 clinics with the realization of at-home death. The use of a clinical pathway (adjusted odds ratio 4.19; 95% confidence interval 1.57-11.19) and the provision of organized palliative care (adjusted odds ratio 19.16; 95% confidence interval 7.56-48.52) were associated with the prediction of at-home death, irrespective of island geography or the number of doctors and nurses. CONCLUSIONS Having a clinical pathway and systematizing palliative care could be important to determine the possibility of at-home deaths for cancer patients in rural clinics in Japan.
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Lin HR, Wang JH, Hsieh JG, Wang YW. Palliative inter-professional learning via cased based tele-videoconference: Experience from the hospice development stage in Taiwan and China. Medicine (Baltimore) 2021; 100:e27741. [PMID: 34871275 PMCID: PMC8568421 DOI: 10.1097/md.0000000000027741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 10/19/2021] [Accepted: 10/23/2021] [Indexed: 11/30/2022] Open
Abstract
ABSTRACT Palliative care in rural areas can be difficult to assess and, often is of lower quality compared to more densely populated regions. A program of multicenter palliative care discussion forum via tele-videoconference may be a promising tool for exchanging valuable experience and constructing a comprehensive hospice care system in Taiwan and China.The multicenter palliative care discussion forum began 1997 and 2010 in Taiwan and China, respectively. In every forum, 1 to 2 cases were presented by multiple field specialists, and multi-dimensional problems were discussed. All of these case reports and reference materials from the forums were analyzed.The conference discussed 199 and 143 cases in Taiwan and China, including 172 and 143 cancer patients. The most common mentioned symptom was pain (66.3% in Taiwan, 96.95% in China). As time went on, the rate of discussion in pain management issues decreased, but the social and psycho-spiritual issues increased in Taiwan. After some major legal and social changes, the discussion of ethical issues increased rapidly. In China, the trends and ranking in discussion of nonpain management issues stabilized and showed most frequently in psycho-spiritual issues, followed by social, ethical and legal issues.Sharing palliative experience via tele-videoconferences is an effective tool to improve the quality of care, and also saves a significant amount of time and expense. Experts in different professions from different hospitals should discuss any palliative problems, share their valuable experience, and ponder a comprehensive hospice care.
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Affiliation(s)
- Huang-Ren Lin
- Department of Family medicine, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
- Department of Family Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Jyh-Gang Hsieh
- Department of Family Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
- Department of Medical Humanities, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Ying-Wei Wang
- Department of Family Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
- Department of Medical Humanities, School of Medicine, Tzu Chi University, Hualien, Taiwan
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Thi Nguyen VA, Könings KD, Scherpbier AJJA, van Merriënboer JJG. Attracting and retaining physicians in less attractive specialties: the role of continuing medical education. HUMAN RESOURCES FOR HEALTH 2021; 19:69. [PMID: 34011364 PMCID: PMC8132429 DOI: 10.1186/s12960-021-00613-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/12/2021] [Indexed: 06/02/2023]
Abstract
BACKGROUND Less attractive specialties in medicine are struggling to recruit and retain physicians. When properly organized and delivered, continuing medical education (CME) activities that include short courses, coaching in the workplace, and communities of practice might offer a solution to this problem. This position paper discusses how educationalists can create CME activities based on the self-determination theory that increase physicians' intrinsic motivation to work in these specialties. MAIN CONTENT The authors propose a set of guidelines for the design of CME activities that offer physicians meaningful training experiences within the limits of the available resources and support. First, to increase physicians' sense of professional relatedness, educationalists must conduct a learner needs assessment, evaluate CME's long-term outcomes in work-based settings, create social learning networks, and involve stakeholders in every step of the CME design and implementation process. Moreover, providing accessible, practical training formats and giving informative performance feedback that authentically connects to learners' working life situation increases physicians' competence and autonomy, so that they can confidently and independently manage the situations in their practice contexts. For each guideline, application methods and instruments are proposed, making use of relevant literature and connecting to the self-determination theory. CONCLUSIONS By reducing feelings of professional isolation and reinforcing feelings of competence and autonomy in physicians, CME activities show promise as a strategy to recruit and retain physicians in less attractive specialties.
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Affiliation(s)
- Van Anh Thi Nguyen
- Department of Medical Education and Skills Laboratory, Hanoi Medical University, Room 504, B Building, 1 Ton That Tung Street, Dongda, Hanoi, 10000 Vietnam
| | - Karen D. Könings
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Albert J. J. A. Scherpbier
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Jeroen J. G. van Merriënboer
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
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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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Lee H, Kim J, Kim S, Kong HJ, Joo H, Lee D, Ryu H. Usability Evaluation of User Requirement-Based Teleconsultation Robots: A Preliminary Report from South Korea. Methods Inf Med 2020; 59:86-95. [PMID: 33126278 DOI: 10.1055/s-0040-1715579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Telepresence robots used to deliver a point-of-care (POC) consultation system that may provide value to enable effective decision making by healthcare providers at care sites. OBJECTIVES This study aimed to evaluate usability of teleconsultation robots, based on endusers' needs, that can improve acceptance in future robot applications. METHODS This is a single group postdesign study using mixed methods to assess the usability of teleconsultation robots using scenarios. To collect opinions from various departments, 15 nurses or physicians currently working at medical institutions in Korea were selected using purposive sampling. The usability evaluation was conducted on healthcare providers twice at the simulation center; the think-aloud method was used and surveys and interviews were conducted to identify problems or improvements that may arise from the use of robots in hospital settings. RESULTS The results showed that perceived usefulness, perceived ease of use, and satisfaction level each scored 4 points or higher out of 7 points, showing usability of midhigh level. Camera angle control and robot driving functions were the most difficult. Other basic robot user interface was shown to be relatively easy. There was no difference in usability depending on the characteristics of the evaluator. Some functions including user interface were modified based on the usability test. CONCLUSION Using robots in health care institutions may support effective communication among healthcare providers, thus contributing to health care improvement.
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Affiliation(s)
- Hyeongsuk Lee
- College of Nursing, Gachon University, Seoul, Republic of Korea
| | - Jeongeun Kim
- College of Nursing and Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea
| | - Sukwha Kim
- Department of Reconstructive Plastic Surgery, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Hyoun-Joong Kong
- Department of Biomedical Engineering, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Hyunjin Joo
- Department of Biomedical Engineering, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Dongkyun Lee
- School of Nursing, Ajou University, Suwon, Republic of Korea
| | - Hyeongju Ryu
- College of Nursing, Seoul National University, Seoul, Republic of Korea
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Frey R, Barham S, Balmer D, Boyd M, Robinson J, Gott M. Palliative care delivery in residential aged care: bereaved family member experiences of the Supportive Hospice Aged Residential Exchange (SHARE) intervention. BMC Palliat Care 2020; 19:127. [PMID: 32807170 PMCID: PMC7433142 DOI: 10.1186/s12904-020-00633-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 08/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background The supportive hospice aged residential exchange (SHARE) is a new model of palliative care education that has been designed for residential aged care. The goal of SHARE is to help clinical staff improve palliative care within residential aged care facilities and to improve specialist palliative care nurses’ knowledge and skill to care for frail older people. Method The experiences of 18 bereaved families concerning the palliative care journey (both at the start and finish of a one-year implementation of SHARE) were explored using semi-structured interviews. Results Three themes were important to bereaved families’ experience: communication with staff, systems of care, and hospice involvement. Sub-themes indicating changes in these three components of care between the start and finish of SHARE was identified. A fourth theme highlighted challenges (relationship with GP, staff shortages, and turnover) that continued across SHARE. Conclusion Findings indicated that SHARE benefited families (improved communication and support) through the end of life journey of their relatives, but challenges remained.
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Affiliation(s)
- Rosemary Frey
- School of Nursing, Faculty of Medical and Health Sciences University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand.
| | - Sophia Barham
- Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Deborah Balmer
- School of Nursing, Faculty of Medical and Health Sciences University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand
| | - Michal Boyd
- School of Nursing, Faculty of Medical and Health Sciences University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand
| | - Jackie Robinson
- School of Nursing, Faculty of Medical and Health Sciences University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand
| | - Merryn Gott
- School of Nursing, Faculty of Medical and Health Sciences University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand
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12
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Kelley LT, Coderre-Ball AM, Dalgarno N, McKeown S, Egan R. Continuing Professional Development for Primary Care Providers in Palliative and End-of-Life Care: A Systematic Review. J Palliat Med 2020; 23:1104-1124. [PMID: 32453657 DOI: 10.1089/jpm.2020.0060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background and Objective: This review updates and expands on previous reviews of educational interventions for primary care providers (PCPs) involved in palliative and end-of-life care (PEoLC) and is the first to include early studies related to medical assistance in dying (MAiD). Methods: A comprehensive search strategy was conducted across five electronic databases to locate published interventional studies related to ongoing PEoLC and/or MAiD education for primary care professionals. A descriptive summary of results and a narrative discussion of common themes and comparisons are provided. Results: Thirty-seven studies met the inclusion criteria. The researchers found a myriad of interventions, including courses based, practical experience, mentoring, and workshops. The researchers categorized results by four domains: attitude, confidence, knowledge, and skills. Across domains, seven educational topics emerged: general care, interprofessional collaboration, nutrition, pain and symptom management, patient communication, and professional coping. Overall, studies employed various methodologies, but often relied on cross-sectionally measured self-assessment. Two articles were found that measured the impact of MAiD education. Conclusion: These findings suggest that PEoLC education can improve PCPs' perceived attitudes, confidence, knowledge, and skills across multiple areas of palliative care practice. While PCPs across studies valued educational interventions, the findings relating to the impact of PEoLC education on PCP's provision of effective PEoLC were unclear. However, most interventions resulted in enhanced confidence and knowledge. To date, there are only two studies that have examined MAiD educational programs. There is a need for studies of higher rigor with more emphasis on follow-up to clarify the impact training has on those involved in PEoLC and MAiD.
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Affiliation(s)
- Leah T Kelley
- Office of Professional Development and Educational Scholarship, Queen's University, Kingston, Ontario, Canada
| | - Angela M Coderre-Ball
- Office of Professional Development and Educational Scholarship, Queen's University, Kingston, Ontario, Canada
| | - Nancy Dalgarno
- Office of Professional Development and Educational Scholarship, Queen's University, Kingston, Ontario, Canada
| | - Sandra McKeown
- Bracken Health Sciences Library, and Queen's University, Kingston, Ontario, Canada
| | - Rylan Egan
- Health Quality Programs, Queen's University, Kingston, Ontario, Canada
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13
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Bauer EH, Bollig G, Dieperink KB. District nurses' views on and experiences with a telemedicine educational programme in palliative care. Scand J Caring Sci 2020; 34:1083-1093. [PMID: 31943328 PMCID: PMC7754273 DOI: 10.1111/scs.12818] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 12/30/2019] [Indexed: 12/26/2022]
Abstract
Background Medical advancements, limited resources and shifting demographics have increased the number of patients with palliative care needs in primary care. To address educational needs, the specialised palliative care team of South Jutland, Denmark, created a telemedicine educational programme in palliative care to empower district nurses. Aim The study aimed to explore district nurses’ views on and experiences with a telemedicine educational programme in palliative care. Research methods A qualitative explorative study based on interpretive description was conducted. Data collection consisted of four focus group interviews with district nurses from three municipalities, supplemented by participant observations and a focus group interview with teachers from the specialised palliative care team. Data were analysed using predominately inductive thematic analysis. Results District nurses (n = 15) who participated in the programme and members of the specialised palliative care team (n = 6) who taught the programme were included. Analysis revealed the following advantages: reaffirming and updating existing knowledge, reduced professional isolation and creation of a forum to promote knowledge dissemination. A disadvantage was limited interaction between teachers and district nurses, questioning suitability for teaching complex palliative care. Initial technical problems affected motivation to participate. Organisational support differed between participating municipalities resulting in varying degrees of programme integration. Despite advantages of IT‐expert‐led sessions, key‐nurse‐led sessions in smaller groups proved more beneficial, suggesting a combination of IT support and key‐nurse management to maximise benefits. Conclusion The use of an inter‐professional telemedicine educational programme to teach palliative care to district nurses is beneficial. However, programmes should be designed for interactivity and address varying educational needs. Key‐nurse roles require managerial and IT support to optimise knowledge dissemination. Further research on implementation of telemedicine education in palliative care is needed.
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Affiliation(s)
- Eithne Hayes Bauer
- Medical Department, University Hospital of Southern Jutland, Aabenraa, Denmark
| | - Georg Bollig
- Medical Department, University Hospital of Southern Jutland, Aabenraa, Denmark.,IRS-centre South Jutland, University of Southern Denmark, Palliative Team and Department for Palliative Care, Medical Department, University Hospital of Southern Jutland, Aabenraa, Denmark
| | - Karin B Dieperink
- Department of Oncology, Odense University Hospital, Odense C, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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14
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Reeve C, Johnston K, Young L. Health Profession Education in Remote or Geographically Isolated Settings: A Scoping Review. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2020; 7:2382120520943595. [PMID: 32754648 PMCID: PMC7378721 DOI: 10.1177/2382120520943595] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/29/2020] [Indexed: 06/11/2023]
Abstract
Remote health has been differentiated from rural health in Australia and defined as isolated, with poor service access and a relatively high proportion of Indigenous residents, necessitating different models of care. Educational strategies for remote health practice are often needs driven and the characteristics of remote health may be used to categorise remote health professional education. This scoping review aims to identify the purpose of health professional education for remote settings, the type of educational strategies implemented and the reported outcomes. A broad search of published literature available in online bibliographic databases was conducted. A total of 33 articles met the review inclusion criteria. A further 7 articles were identified for inclusion in the review through citation searches and the authors' networks giving a total of 40 articles. Six primary themes were established based on the educational purpose: (1) cultural competency; (2) social accountability; (3) rural and remote skill development for the general workforce; (4) remote specialisation; (5) specialist skills required for a remote workforce; and (6) remote teaching. These themes also reflect the philosophical change over time recognising remote health as a separate discipline and its value as a distinctive and efficacious learning environment. The concept of education for remote practice is proposed to describe this unique leaning environment which encompasses critical pedagogy to develop a sense of agency and social accountability, embedding the delivery of primary health care through service learning and developing relationships in a context which is transformative.
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Affiliation(s)
- Carole Reeve
- James Cook University General Practice
Training, College of Medicine and Dentistry, Anton Breinl Research Centre for Health
Systems Strengthening, James Cook University, Townsville, QLD, Australia
| | - Karen Johnston
- College of Medicine and Dentistry, Anton
Breinl Research Centre for Health Systems Strengthening, James Cook University,
Townsville, QLD, Australia
| | - Louise Young
- College of Medicine and Dentistry, Anton
Breinl Research Centre for Health Systems Strengthening, James Cook University,
Townsville, QLD, Australia
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15
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Impact of Project ECHO Models of Medical Tele-Education: a Systematic Review. J Gen Intern Med 2019; 34:2842-2857. [PMID: 31485970 PMCID: PMC6854140 DOI: 10.1007/s11606-019-05291-1] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/31/2019] [Accepted: 07/31/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Extension for Community Healthcare Outcomes (ECHO) and related models of medical tele-education are rapidly expanding; however, their effectiveness remains unclear. This systematic review examines the effectiveness of ECHO and ECHO-like medical tele-education models of healthcare delivery in terms of improved provider- and patient-related outcomes. METHODS We searched English-language studies in PubMed, Embase, and PsycINFO databases from 1 January 2007 to 1 December 2018 as well as bibliography review. Two reviewers independently screened citations for peer-reviewed publications reporting provider- and/or patient-related outcomes of technology-enabled collaborative learning models that satisfied six criteria of the ECHO framework. Reviewers then independently abstracted data, assessed study quality, and rated strength of evidence (SOE) based on Cochrane GRADE criteria. RESULTS Data from 52 peer-reviewed articles were included. Forty-three reported provider-related outcomes; 15 reported patient-related outcomes. Studies on provider-related outcomes suggested favorable results across three domains: satisfaction, increased knowledge, and increased clinical confidence. However, SOE was low, relying primarily on self-reports and surveys with low response rates. One randomized trial has been conducted. For patient-related outcomes, 11 of 15 studies incorporated a comparison group; none involved randomization. Four studies reported care outcomes, while 11 reported changes in care processes. Evidence suggested effectiveness at improving outcomes for patients with hepatitis C, chronic pain, dementia, and type 2 diabetes. Evidence is generally low-quality, retrospective, non-experimental, and subject to social desirability bias and low survey response rates. DISCUSSION The number of studies examining ECHO and ECHO-like models of medical tele-education has been modest compared with the scope and scale of implementation throughout the USA and internationally. Given the potential of ECHO to broaden access to healthcare in rural, remote, and underserved communities, more studies are needed to evaluate effectiveness. This need for evidence follows similar patterns to other service delivery models in the literature.
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16
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The Changing Nature of Palliative Care: Implications for Allied Health Professionals' Educational and Training Needs. Healthcare (Basel) 2019; 7:healthcare7040112. [PMID: 31569334 PMCID: PMC6955877 DOI: 10.3390/healthcare7040112] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 09/24/2019] [Accepted: 09/26/2019] [Indexed: 11/16/2022] Open
Abstract
CareSearch is an Australian Government Department of Health funded repository of evidence-based palliative care information and resources. The CareSearch Allied Health Hub was developed in 2013 to support all allied health professionals working with palliative care clients in all clinical settings. This cross-sectional online survey sought to elicit allied health professionals palliative care experiences and subsequent considerations for educational and clinical practice needs. The survey was disseminated nationally via a range of organisations. Data was collected about palliative care knowledge, experience working with palliative care clients and professional development needs. Data were evaluated by profession, experience and practice setting. In total, 217 respondents answered one or more survey questions (94%). Respondents (65%) reported seeing >15 palliative care clients per month with 84% seen in hospital and community settings. Undergraduate education underprepared or partially prepared allied health professionals to work with these clients (96%) and 67% identified the need for further education. Access to postgraduate professional development was limited by available backfill and funding. Study findings support the importance of free, accessible, relevant educational and professional development resources to support clinical practice. This is particularly relevant for allied health professionals who have limited opportunities to attend formal professional development sessions.
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17
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Ding J, Saunders C, Cook A, Johnson CE. End-of-life care in rural general practice: how best to support commitment and meet challenges? BMC Palliat Care 2019; 18:51. [PMID: 31238934 PMCID: PMC6593492 DOI: 10.1186/s12904-019-0435-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 06/11/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Few studies have specifically assessed the scope, nature and challenges of palliative and end-of-life care in rural general practice. These knowledge gaps limit the development of evidence-based policies and services for patients in the last months of life. This study aimed to explore the perspectives of general practitioners (GPs) and other stakeholders on rural GPs' involvement and challenges in providing palliative and end-of-life care in regional Australia. METHODS A qualitative study involving five focus groups with 26 GPs based in rural/regional Western Australia together with 15 individual telephone interviews with four GPs and 11 other stakeholders involved in end-of-life care across Australia. RESULTS The rural GPs' central role in end-of-life care was recognized by the majority of participants but multiple challenges were also identified. Some challenges were comparable to those found in urban settings but others were more pronounced, including resource limitations and lack of training. Inappropriate payment models discouraged GPs' involvement in some aspects of end-of-life care, such as case conferences and home visits. Compared to GPs in urban settings, those in rural/regional communities often reported closer doctor-patient relationships and better care integration and collaboration. These positive aspects of care could be further developed to enhance service provision. Our study highlighted the importance of regular interactions with other professionals and patients in providing end-of-life care, but many GPs and other stakeholders found such interactions more challenging than the more "technical" aspects of care. CONCLUSIONS Rural/regional GPs appear to be disproportionately affected by inappropriate payment models and limited resources, but may benefit from closer doctor-patient relationships and better care integration and collaboration relative to urban GPs. Systematic collection of empirical data on GP management at end-of-life is required to build on these strengths and address the challenges.
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Affiliation(s)
- Jinfeng Ding
- School of Population and Global Health, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia 6009 Australia
| | - Christobel Saunders
- Medical School, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009 Australia
| | - Angus Cook
- School of Population and Global Health, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia 6009 Australia
| | - Claire E. Johnson
- School of Nursing and Midwifery, Monash University, Wellington Road, Clayton, Victoria 3800 Australia
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18
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Conlon MSC, Caswell JM, Santi SA, Ballantyne B, Meigs ML, Knight A, Earle CC, Hartman M. Access to Palliative Care for Cancer Patients Living in a Northern and Rural Environment in Ontario, Canada: The Effects of Geographic Region and Rurality on End-of-Life Care in a Population-Based Decedent Cancer Cohort. Clin Med Insights Oncol 2019; 13:1179554919829500. [PMID: 30799969 PMCID: PMC6378418 DOI: 10.1177/1179554919829500] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 12/18/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Access to palliative care has been associated with improving quality of life and reducing the use of potentially aggressive end-of-life care. However, many challenges and barriers exist in providing palliative care to residents in northern and rural settings in Ontario, Canada. AIM The purpose of this study was to examine access to palliative care and associations with the use of end-of-life care in a decedent cohort of northern and southern, rural and urban, residents. DESIGN Using linked administrative databases, residents were classified into geographic and rural categories. Regression methods were used to define use and associations of palliative and end-of-life care and death in acute care hospital. SETTING/PARTICIPANTS A decedent cancer cohort of Ontario residents (2007-2012). RESULTS Northern rural residents were less likely to receive palliative care (adjusted odds ratio [OR] = 0.90, 95% confidence interval [CI]: 0.83-0.97). Those not receiving palliative care were more likely to receive potentially aggressive end-of-life care and die in an acute care hospital (adjusted OR = 1.20, 95% CI: 1.02-1.41). CONCLUSIONS Palliative care was significantly associated with reduced use of aggressive end-of-life care; however, disparities exist in rural locations, especially those in the north. Higher usage of emergency department (ED) and hospital resources at end of life in rural locations also reflects differing roles of rural community hospitals compared with urban hospitals. Improving access to palliative care in rural and northern locations is an important care issue and may reduce use of potentially aggressive end-of-life care.
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Affiliation(s)
- Michael SC Conlon
- Epidemiology, Outcomes & Evaluation Research, Health Sciences North Research Institute (HSNRI), Sudbury, ON, Canada
- ICES North Satellite Site, Health Sciences North Research Institute (HSNRI), Sudbury, ON, Canada
- Laurentian University, Sudbury, ON, Canada
- Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Joseph M Caswell
- Epidemiology, Outcomes & Evaluation Research, Health Sciences North Research Institute (HSNRI), Sudbury, ON, Canada
- ICES North Satellite Site, Health Sciences North Research Institute (HSNRI), Sudbury, ON, Canada
| | - Stacey A Santi
- Epidemiology, Outcomes & Evaluation Research, Health Sciences North Research Institute (HSNRI), Sudbury, ON, Canada
| | - Barbara Ballantyne
- Systemic Therapy Program, Northeast Cancer Centre, Health Sciences North, Sudbury, ON, Canada
- Northeast Cancer Centre, Health Sciences North Research Institute, Sudbury, ON, Canada
- The Ontario Palliative Care Network, Toronto, ON, Canada
| | - Margaret L Meigs
- Epidemiology, Outcomes & Evaluation Research, Health Sciences North Research Institute (HSNRI), Sudbury, ON, Canada
| | - Andrew Knight
- Northern Ontario School of Medicine, Sudbury, ON, Canada
- Systemic Therapy Program, Northeast Cancer Centre, Health Sciences North, Sudbury, ON, Canada
- Northeast Cancer Centre, Health Sciences North Research Institute, Sudbury, ON, Canada
- The Ontario Palliative Care Network, Toronto, ON, Canada
- Cancer Care Ontario, Toronto, ON, Canada
| | - Craig C Earle
- Canadian Partnership Against Cancer, Toronto, ON, Canada
| | - Mark Hartman
- Northeast Cancer Centre, Health Sciences North Research Institute, Sudbury, ON, Canada
- Cancer Care Ontario, Toronto, ON, Canada
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19
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King L, Kremser S, Deam P, Henry J, Reid D, Orrock P, Grace S. Clinical reasoning in osteopathy: Experiences of novice and experienced practitioners. INT J OSTEOPATH MED 2018. [DOI: 10.1016/j.ijosm.2018.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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Furman M, Harild L, Anderson M, Irish J, Nguyen K, Wright FC. The Development of Practice Guidelines for a Palliative Care Multidisciplinary Case Conference. J Pain Symptom Manage 2018; 55:395-401. [PMID: 28867461 DOI: 10.1016/j.jpainsymman.2017.08.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/16/2017] [Accepted: 08/17/2017] [Indexed: 11/20/2022]
Abstract
CONTEXT In Ontario, we identified that few hospitals have developed multi-disciplinary case conferences or forums for discussion of patients with palliative care issues. OBJECTIVE We describe the process of creating a province-wide standards document for palliative care multidisciplinary case conferences (pMCCs). METHODS A provincial survey and a multidisciplinary cancer conference symposium identified pMCCs as a priority. A literature search focusing on pMCCs and their implementation was completed as well as a current state assessment (survey and interviews) to understand challenges with existing pMCCs in Ontario. A working group was then assembled to draft a recommendation report that was finalized by an expert panel. RESULTS A total of 22 articles were identified and 10 were used by the working group to create a framework for the pMCC guideline. The current state assessment identified substantial variability in pMCC structure and function. The expert panel made recommendations about meeting format (multidisciplinary discussion encouraged), frequency (at least every two weeks), type of cases to present, attendees (palliative care, nursing, primary care, social work, and community nursing), provider roles and responsibilities, and institutional requirements (pMCC coordinator, meeting room and videoconference capability). All patients (not just those with cancer) with palliative care needs were to be discussed at the pMCC, and pMCCs should serve as a crucial link between the hospital and community. CONCLUSION We have described the process of creating the first pMCC guideline. A key component of this guideline is that pMCCs should serve as a link between the hospital and community.
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Affiliation(s)
- Matthew Furman
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Laura Harild
- Department of Family Practice, Trillium Health Partners, Mississauga, Ontario, Canada
| | | | | | | | - Frances C Wright
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
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21
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Lee HS, Kim J. Scenario-Based Assessment of User Needs for Point-of-Care Robots. Healthc Inform Res 2018; 24:12-21. [PMID: 29503748 PMCID: PMC5820081 DOI: 10.4258/hir.2018.24.1.12] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 01/15/2018] [Accepted: 01/22/2018] [Indexed: 11/23/2022] Open
Abstract
Objectives This study aimed to derive specific user requirements and barriers in a real medical environment to define the essential elements and functions of two types of point-of-care (POC) robot: a telepresence robot as a tool for teleconsultation, and a bedside robot to provide emotional care for patients. Methods An analysis of user requirements was conducted; user needs were gathered and identified, and detailed, realistic scenarios were created. The prototype robots were demonstrated in physical environments for envisioning and evaluation. In all, three nurses and three clinicians participated as evaluators to observe the demonstrations and evaluate the robot systems. The evaluators were given a brief explanation of each scene and the robots' functionality. Four major functions of the teleconsultation robot were defined and tested in the demonstration. In addition, four major functions of the bedside robot were evaluated. Results Among the desired functions for a teleconsultation robot, medical information delivery and communication had high priority. For a bedside robot, patient support, patient monitoring, and healthcare provider support were the desired functions. The evaluators reported that the teleconsultation robot can increase support from and access to specialists and resources. They mentioned that the bedside robot can improve the quality of hospital life. Problems identified in the demonstration were those of space conflict, communication errors, and safety issues. Conclusions Incorporating this technology into healthcare services will enhance communication and teamwork skills across distances and thereby facilitate teamwork. However, repeated tests will be needed to evaluate and ensure improved performance.
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Affiliation(s)
- Hyeong Suk Lee
- College of Nursing, Seoul National University, Seoul, Korea
| | - Jeongeun Kim
- College of Nursing, Seoul National University, Seoul, Korea.,Research Institute of Nursing Science, Seoul National University, Seoul, Korea
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22
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Brighton LJ, Koffman J, Hawkins A, McDonald C, O'Brien S, Robinson V, Khan SA, George R, Higginson IJ, Selman LE. A Systematic Review of End-of-Life Care Communication Skills Training for Generalist Palliative Care Providers: Research Quality and Reporting Guidance. J Pain Symptom Manage 2017; 54:417-425. [PMID: 28782701 DOI: 10.1016/j.jpainsymman.2017.04.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 02/17/2017] [Accepted: 04/12/2017] [Indexed: 11/19/2022]
Abstract
CONTEXT End-of-life care (EoLC) communication skills training for generalist palliative care providers is recommended in policy guidance globally. Although many training programs now exist, there has been no comprehensive evidence synthesis to inform future training delivery and evaluation. OBJECTIVES To identify and appraise how EoLC communication skills training interventions for generalist palliative care providers are developed, delivered, evaluated, and reported. METHODS Systematic review. Ten electronic databases (inception to December 2015) and five relevant journals (January 2004 to December 2015) were searched. Studies testing the effectiveness of EoLC communication skills training for generalists were included. Two independent authors assessed study quality. Descriptive statistics and narrative synthesis are used to summarize the findings. RESULTS From 11,441 unique records, 170 reports were identified (157 published, 13 unpublished), representing 160 evaluation studies of 153 training interventions. Of published papers, eight were of low quality, 108 medium, and 41 high. Few interventions were developed with service user involvement (n = 7), and most were taught using a mixture of didactics (n = 123), reflection and discussion (n = 105), and role play (n = 86). Evaluation designs were weak: <30% were controlled, <15% randomized participants. Over half (n = 85) relied on staff self-reported outcomes to assess effectiveness, and 49% did not cite psychometrically validated measures. Key information (e.g., training duration, participant flow) was poorly reported. CONCLUSIONS Despite a proliferation of EoLC communication skills training interventions in the literature, evidence is limited by poor reporting and weak methodology. Based on our findings, we present a CONSORT statement supplement to improve future reporting and encourage more rigorous testing.
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Affiliation(s)
- Lisa Jane Brighton
- Department of Palliative Care, Policy, and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK.
| | - Jonathan Koffman
- Department of Palliative Care, Policy, and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | - Amy Hawkins
- Phyllis Tuckwell Hospice, Farnham, UK; Frimley Park Hospital NHS Foundation Trust, Frimley, UK
| | - Christine McDonald
- Department of Palliative Care, Policy, and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | - Suzanne O'Brien
- Department of Palliative Care, Policy, and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | - Vicky Robinson
- Department of Palliative Care, Policy, and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | | | - Rob George
- Guy's and St Thomas' NHS Foundation Trust, London, UK; St Christopher's Hospice, London, UK
| | - Irene J Higginson
- Department of Palliative Care, Policy, and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | - Lucy Ellen Selman
- Department of Palliative Care, Policy, and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK; Population Health Sciences, University of Bristol, Bristol, United Kingdom
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23
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Berggren E, Ödlund Olin A, Orrevall Y, Strang P, Johansson SE, Törnkvist L. Early palliative home care: Evaluation of an interprofessional educational intervention for district nurses and general practitioners about nutritional care. SAGE Open Med 2017; 5:2050312117726465. [PMID: 28839942 PMCID: PMC5564855 DOI: 10.1177/2050312117726465] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 07/17/2017] [Indexed: 01/06/2023] Open
Abstract
Background: Teamwork is important in early palliative home care, and interprofessional education is required to achieve teamwork. It is thus crucial to ensure that interprofessional education works well for the members of all participating professions because levels of knowledge and educational needs may vary. Aim: To evaluate, by profession, the effectiveness of an interprofessional educational intervention for district nurses and general practitioners on three areas of nutritional care for patients in a palliative phase. Design: A quasi-experimental study that used a computer-based, study-specific questionnaire to evaluate the effectiveness of the intervention. The continuing education in primary health care (ConPrim®) model was used to create the intervention. ConPrim includes a web-based program, a practical exercise and a case seminar, all with interprofessional training. Setting: Primary health care centers in Stockholm County, Sweden. Intervention group (n = 87; 48 district nurses, 39 general practitioners); control group (n = 53; 36 district nurses, 17 general practitioners). Results: The total intervention effect was significant in all three areas, p = 0.000–0.004. The intervention effects were similar and significant for both professions in areas 1 and 2. In area 3, the intervention effects were significant for general practitioners but not for district nurses. Conclusions: The intervention seems promising, as it may create better prerequisites for teamwork and caring for patients living at home. However, it needs to be optimized to better increase district nurses’ level of knowledge (area 3).
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Affiliation(s)
- Erika Berggren
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Academic Primary Health Care Centre, Stockholm County Council, Sweden
| | - Ann Ödlund Olin
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Quality and Patient Safety, Karolinska University Hospital, Stockholm, Sweden
| | - Ylva Orrevall
- Function Area Clinical Nutrition, Karolinska University Hospital, Stockholm, Sweden.,Department of Learning, Informatics, Management, and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Peter Strang
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Stockholms Sjukhem Foundation, Stockholm, Sweden
| | - Sven-Erik Johansson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Academic Primary Health Care Centre, Stockholm County Council, Sweden
| | - Lena Törnkvist
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Academic Primary Health Care Centre, Stockholm County Council, Sweden
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Berndt A, Murray CM, Kennedy K, Stanley MJ, Gilbert-Hunt S. Effectiveness of distance learning strategies for continuing professional development (CPD) for rural allied health practitioners: a systematic review. BMC MEDICAL EDUCATION 2017; 17:117. [PMID: 28701199 PMCID: PMC5506644 DOI: 10.1186/s12909-017-0949-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 06/26/2017] [Indexed: 05/06/2023]
Abstract
BACKGROUND Allied health professionals working in rural areas face unique challenges, often with limited access to resources. Accessing continuing professional development is one of those challenges and is related to retention of workforce. Effectiveness of distance learning strategies for continuing professional development in rural allied healthcare workers has not been evaluated. METHODS We searched 17 databases and the grey literature up to September 2016 following the PRISMA guidelines. Any primary studies were included that focussed on allied health and distance delivery regardless of education topic or study design. Two independent reviewers extracted data and critically appraised the selected studies. RESULTS The search returned 5257 results. With removal of duplicate references, we reviewed 3964 article titles and abstracts; n = 206 appeared potentially eligible and were scrutinised via full text screening; n = 14 were included. Studies were published between 1997 and 2016, were of varied methodological quality and were predominantly from Australia, USA and Canada with a focus on satisfaction of learners with the delivery method or on measures of educational outcomes. Technologies used to deliver distance education included video conference, teleconference, web based platforms and virtual reality. Early papers tended to focus more on the technology characteristics than educational outcomes. Some studies compared technology based delivery to face to face modes and found satisfaction and learning outcomes to be on par. Only three studies reported on practice change following the educational intervention and, despite a suggestion there is a link between the constructs, none measured the relationship between access to continuing professional development and workforce retention. CONCLUSION Technology based options of delivery have a high utility, however the complex inter-relatedness of time, use, travel, location, costs, interactivity, learning outcomes and educational design suggest a need for more sophisticated consideration by educational providers. TRIAL REGISTRATION Registration with PROSPERO 30 June 2016: CRD42016041588 .
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Affiliation(s)
- Angela Berndt
- University of South Australia, School of Health Sciences, Adelaide, Australia
| | - Carolyn M. Murray
- University of South Australia, School of Health Sciences, Adelaide, Australia
| | - Kate Kennedy
- University of South Australia, School of Health Sciences, Adelaide, Australia
| | - Mandy J. Stanley
- University of South Australia, School of Health Sciences, Adelaide, Australia
| | - Susan Gilbert-Hunt
- University of South Australia, School of Health Sciences, Adelaide, Australia
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Spilsbury K, Rosenwax L, Arendts G, Semmens JB. The Association of Community-Based Palliative Care With Reduced Emergency Department Visits in the Last Year of Life Varies by Patient Factors. Ann Emerg Med 2017; 69:416-425. [DOI: 10.1016/j.annemergmed.2016.11.036] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 07/24/2016] [Accepted: 08/03/2016] [Indexed: 10/20/2022]
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Perceptions of the care received from Australian palliative care services: A caregiver perspective. Palliat Support Care 2017; 16:198-208. [PMID: 28357973 DOI: 10.1017/s1478951517000177] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
ABSTRACTBackground:Caregiver satisfaction and experience surveys help health professionals to understand, measure, and improve the quality of care provided for patients and their families. OBJECTIVE Our aim was to explore caregiver perceptions of the care received from Australian specialist palliative care services. METHOD Caregivers of patients receiving palliative care in services registered with Australia's Palliative Care Outcomes Collaboration were invited to participate in a caregiver survey. The survey included the FAMCARE-2 and four items from the Ongoing Needs Identification: Caregiver Profile questionnaire. RESULTS Surveys were completed by 1,592 caregivers from 49 services. Most respondents reported high satisfaction and positive experiences. Caregivers receiving care from community-based palliative care teams were less satisfied with the management of physical symptoms and comfort (odds ratio [OR] = 0.29; 95% confidence interval [CI95%] = 0.14, 0.59), with patient psychological care (OR = 0.56; CI95% = 0.32, 0.98), and with family support (OR = 0.52; CI95% = 0.35, 0.77) than caregivers of patients in an inpatient setting. If aged over 60 years, caregivers were less likely to have their information needs met regarding available support services (OR = 0.98; CI95% = 0.97, 0.98) and carer payments (OR = 0.99; CI95% = 0.98, 1.00). Also, caregivers were less likely to receive adequate information about carer payments if located in an outer regional area (OR = 0.41; CI95% = 0.25, 0.64). With practical training, caregivers receiving care from community services reported inadequate information provision to support them in caring for patients (OR = 0.60; CI95% = 0.45, 0.81). SIGNIFICANCE OF RESULTS While our study identified caregivers as having positive and satisfactory experiences across all domains of care, there is room for improvement in the delivery of palliative care across symptom management, as well as patient and caregiver support, especially in community settings. Caregiver surveys can facilitate the identification and evaluation of both patients' and caregivers' experiences, satisfaction, distress, and unmet needs.
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Palumbo MV, De Gagne JC, Murphy G. Interprofessional care of elders. J Am Assoc Nurse Pract 2016; 28:465-70. [DOI: 10.1002/2327-6924.12368] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 03/06/2016] [Indexed: 11/09/2022]
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Spetz J, Dudley N, Trupin L, Rogers M, Meier DE, Dumanovsky T. Few Hospital Palliative Care Programs Meet National Staffing Recommendations. Health Aff (Millwood) 2016; 35:1690-7. [DOI: 10.1377/hlthaff.2016.0113] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Joanne Spetz
- Joanne Spetz ( ) is a professor of economics at the Philip R. Lee Institute for Health Policy Studies and the Healthforce Center at the University of California, San Francisco (UCSF)
| | - Nancy Dudley
- Nancy Dudley is a VA Quality Scholars fellow with the UCSF Department of Geriatrics and the San Francisco Veterans Affairs Medical Center
| | - Laura Trupin
- Laura Trupin is an epidemiologist in the Philip R. Lee Institute for Health Policy Studies at UCSF
| | - Maggie Rogers
- Maggie Rogers is senior research associate at the Center to Advance Palliative Care, in New York City
| | - Diane E. Meier
- Diane E. Meier is the director of the Center to Advance Palliative Care and a professor in the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai, in New York City
| | - Tamara Dumanovsky
- Tamara Dumanovsky is a vice president for research and analytics at the Center to Advance Palliative Care
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Cameron M, Ray R, Sabesan S. Remote supervision of medical training via videoconference in northern Australia: a qualitative study of the perspectives of supervisors and trainees. BMJ Open 2015; 5:e006444. [PMID: 25795687 PMCID: PMC4368981 DOI: 10.1136/bmjopen-2014-006444] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Telemedicine has revolutionised the ability to provide care to patients, relieve professional isolation and provide guidance and supervision to junior medical officers in rural areas. This study evaluated the Townsville teleoncology supervision model for the training of junior medical officers in rural areas of North Queensland, Australia. Specifically, the perspectives of junior and senior medical officers were explored to identify recommendations for future implementation. DESIGN A qualitative approach incorporating observation and semistructured interviews was used to collect data. Interviews were uploaded into NVivo 10 data management software. Template analysis enabled themes to be tested and developed through consensus between researchers. SETTING One tertiary level and four secondary level healthcare centres in rural and regional Queensland, Australia. PARTICIPANTS 10 junior medical officers (Interns, Registrars) and 10 senior medical officers (Senior Medical Officers, Consultants) who participated in the Townsville teleoncology model of remote supervision via videoconference (TTMRS) were included in the study. PRIMARY AND SECONDARY OUTCOME MEASURES Perspectives on the telemedicine experience, technology, engagement, professional support, satisfaction and limitations were examined. Perspectives on topics raised by participants were also examined as the interviews progressed. RESULTS Four major themes with several subthemes emerged from the data: learning environment, beginning the learning relationship, stimulus for learning and practicalities of remote supervision via videoconference. While some themes were consistent with the current literature, new themes like increased professional edge, recognising non-verbal cues and physical examination challenges were identified. CONCLUSIONS Remote supervision via videoconference provides readily available guidance to trainees supporting their delivery of appropriate care to patients. However, resources required for upskilling, training in the use of supervision via videoconference, administration issues and nursing support, as well as physical barriers to examinations, must be addressed to enable more efficient implementation.
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Affiliation(s)
- Miriam Cameron
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Robin Ray
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Sabe Sabesan
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- Townsville Hospital, Townsville, Queensland, Australia
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