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Pergolizzi J, LeQuang JAK, Wagner M, Varrassi G. Challenges in Palliative Care in Latin America: A Narrative Review. Cureus 2024; 16:e60698. [PMID: 38899235 PMCID: PMC11186623 DOI: 10.7759/cureus.60698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 05/14/2024] [Indexed: 06/21/2024] Open
Abstract
In "graying" populations with extended lifespans and survivable forms of cancer, palliative services become increasingly important but may be difficult to introduce into public discourse, public policy, and healthcare systems. Latin America (LATAM) faces many challenges as it introduces and, in some cases, develops its palliative care programs; though the challenges faced here are in many ways universal ones, LATAM approaches may be unique and based on the region's specific culture, politics, and economics. This narrative review based on a literature search identified 10 main themes that can be interpreted as challenges and opportunities for palliative care in LATAM. These challenges are integrating palliation into healthcare systems; public policy and funding; therapeutic obstinacy; changing demographics; access to services; analgesia; the role of religion, spirituality, and folk medicine; social determinants of palliative care; low health literacy; and limited clinician training. Some of the LATAM nations have palliative programs and palliative care training in place while others are developing these systems. Integrating this care into existing healthcare and reimbursement systems has been a challenge. A notable challenge in LATAM is also access to care since palliative programs tend to cluster in metropolitan areas and create hardships for rural citizens to access them. The better-defined role of familial caregivers and telehealth may be important factors in the expansion of palliative care in LATAM and beyond.
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Affiliation(s)
- Joseph Pergolizzi
- Anesthesiology - Pain Medicine and Critical Care Medicine, NEMA Research, Inc., Naples, USA
| | | | - Morgan Wagner
- Entrepreneur Program, NEMA Research, Inc., Naples, USA
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Murphy R, Barnes CJ, Enright PD, Gratton V, Bush SH. Mapping an undergraduate medical education curriculum against national and international palliative care reference learning objectives. BMC MEDICAL EDUCATION 2024; 24:105. [PMID: 38303063 PMCID: PMC10836050 DOI: 10.1186/s12909-024-05082-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/22/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND The teaching of palliative care competencies is an essential component of undergraduate medical education. There is significant variance in the palliative care content delivered in undergraduate medical curricula, revealing the utility of reference standards to guide curricular development and assessment. To evaluate our university's undergraduate palliative care teaching, we undertook a curriculum mapping exercise, comparing official learning objectives to the national Educating Future Physicians in Palliative and End-of-Life Care (EFPPEC) and the international Palliative Education Assessment Tool (PEAT) reference objectives. METHODS Multiple assessors independently compared our university's UGME learning objectives with EFPPEC and PEAT reference objectives to determine the degree-of-coverage. Visual curriculum maps were created to depict in which part of the curriculum each objective is delivered and by which medical specialty. RESULTS Of 122 EFPPEC objectives, 55 (45.1%) were covered fully, 42 (34.4%) were covered partially, and 25 (20.5%) were not covered by university objectives. Of 89 PEAT objectives, 40 (44.9%) were covered fully, 35 (39.3%) were covered partially, and 14 (15.7%) were not covered by university objectives. CONCLUSIONS The majority of EFPPEC and PEAT reference objectives are fully or partially covered in our university's undergraduate medical curriculum. Our approach could serve as a guide for others who endeavour to review their universities' specialty-specific medical education against reference objectives. Future curriculum development should target the elimination of identified gaps and evaluate the attainment of palliative care competencies by medical learners.
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Affiliation(s)
- Rebekah Murphy
- Department of Medicine, Division of Palliative Care, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada.
- Department of Palliative Care, Bruyère Continuing Care, Saint-Vincent Hospital, 60 Cambridge St N, Ottawa, ON, K1R 7A5, Canada.
- Department of Medicine, Queensway Carleton Hospital, 3045 Baseline Rd, Ottawa, ON, K2H 8P4, Canada.
| | - Christopher J Barnes
- Department of Medicine, Division of Palliative Care, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada
- Department of Palliative Care, Bruyère Continuing Care, Saint-Vincent Hospital, 60 Cambridge St N, Ottawa, ON, K1R 7A5, Canada
| | - Paula D Enright
- Department of Medicine, Division of Palliative Care, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada
- Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada
| | - Valerie Gratton
- Department of Medicine, Division of Palliative Care, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada
- Institut du Savoir Montfort, 713 Montréal Rd, Ottawa, ON, K1K 0T2, Canada
- Department of Family Medicine, Montfort Hospital, 713 Montréal Rd, Ottawa, ON, K1K 0T2, Canada
| | - Shirley H Bush
- Department of Medicine, Division of Palliative Care, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada
- Department of Palliative Care, Bruyère Continuing Care, Saint-Vincent Hospital, 60 Cambridge St N, Ottawa, ON, K1R 7A5, Canada
- Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada
- Bruyère Research Institute, 43 Bruyère St, Ottawa, ON, K1N 5C8, Canada
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Hinzmann D, Wijnen-Meijer M, Corazza L, Becker V, Kagerbauer S, Haseneder R, Berberat PO, Jedlicska N. Experiences of medical students and nursing trainees from unexpected death through simulation training. BMC MEDICAL EDUCATION 2023; 23:667. [PMID: 37710319 PMCID: PMC10503193 DOI: 10.1186/s12909-023-04638-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 08/30/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Dying in simulation training is controversially discussed. On the one hand, the danger of an emotional overload of the learners is pointed out. On the other hand, dying in simulation settings is addressed as an opportunity to prepare future health professionals to deal with patient death. The present study investigates how medical students and nursing trainees experience the sudden death of a simulated patient and how and under which conditions it can be valuable to simulate the patient's death. METHODS At the TUM School of Medicine in Munich, Germany, we developed an interprofessional, simulation-based course in which participants were unexpectedly confronted with a cardiac arrest scenario within which resuscitation had to be discontinued due to an advanced directive. After the course, focus groups were conducted with nine medical students and six nursing trainees. Data were analysed using Grounded Theory techniques. RESULTS The participants reported low to high emotional involvement. The active renunciation of life-sustaining measures was felt to be particularly formative and caused a strange feeling and helplessness. Questions of what could have been done differently determined interviewees' thoughts. The participants appreciated the opportunity to experience what it feels like to lose a patient. The course experience encouraged interviewees to reflect on dying and the interviewees explained that they feel better prepared to face death after the course. The unexpected character of the confrontation, presence of the advanced directive and debriefing positively affected the impact of the simulation. CONCLUSIONS The study recognises simulation training as a promising approach for preparing future health care professionals to encounter a patient's death.
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Affiliation(s)
- Dominik Hinzmann
- TUM Medical Education Center, TUM School of Medicine, Technical University of Munich, Munich, Germany
- Department of Anesthesiology and Intensive Care, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Marjo Wijnen-Meijer
- TUM Medical Education Center, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Laura Corazza
- TUM Medical Education Center, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Veronika Becker
- TUM Medical Education Center, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Simone Kagerbauer
- Department of Anesthesiology and Intensive Care, TUM School of Medicine, Technical University of Munich, Munich, Germany
- Department of Anesthesiology and Intensive Care Medicine, University of Ulm, Ulm, Germany
| | - Rainer Haseneder
- TUM Medical Education Center, TUM School of Medicine, Technical University of Munich, Munich, Germany
- Department of Anesthesiology and Intensive Care, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Pascal O Berberat
- TUM Medical Education Center, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Nana Jedlicska
- TUM Medical Education Center, TUM School of Medicine, Technical University of Munich, Munich, Germany.
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Zhu L, Zhang N, Hu Y, Xu Y, Luo T, Xiang Y, Jiang S, Zhang Z, Chen M, Xiong Y. Influencing factors of knowledge, attitude and behavior in children's palliative care among pediatric healthcare workers: a cross-sectional survey in China. BMC Palliat Care 2023; 22:67. [PMID: 37280672 DOI: 10.1186/s12904-023-01187-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 05/25/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Palliative care has become a key medical field worldwide. Although research relating to adult palliative care is well-established, less is known about children's palliative care (CPC). Therefore, this study investigated the knowledge, attitude and behavior of pediatric healthcare workers (PHWs) regarding CPC and analyzed the influencing factors for the implementation and development of CPC. METHODS A cross-sectional survey of 407 PHWs was carried out in a Chinese province from November 2021 to April 2022. The questionnaire consisted of two parts: a general information form and questions on the knowledge, attitude and behavior of PHWs about CPC. Data were analyzed using t-test, ANOVA and multiple regression analysis. RESULTS The total score of the PHWs' knowledge, attitude and behavior about CPC was 69.98, which was at a moderate level. PHWs' CPC knowledge, attitude, and behavior are positively correlated.The most important influencing factors were working years, highest education, professional title, job position, marital status, religion, grade of hospital (I, II or III), type of medical institution, experience of caring for a terminally ill child/kinsfolk and total hours of CPC education and training received. CONCLUSIONS In this study, PHWs in a Chinese province had the lowest scores on the knowledge dimension of CPC, with moderate attitude and behavior and various influencing factors. In addition to professional title, highest education and working years, it is also worth noting that the type of medical institution and marital status also affected the score. Continuing education and training of PHWs in CPC should be emphasized by the administrators of relevant colleges and medical institutions. Future research should start with the above-mentioned influencing factors and focus on setting up targeted training courses and evaluating the post-training effects.
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Affiliation(s)
- Lihui Zhu
- Nursing Teaching and Research Section, Hunan Cancer Hospital/The Afliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China.
| | - Na Zhang
- Nursing Teaching and Research Section, Hunan Cancer Hospital/The Afliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
- Department of Nursing, Hunan Children's Hospital, Changsha, China
| | - Yaojia Hu
- Department of Ophthalmology, Hunan Children's Hospital, Changsha, China
| | - Yi Xu
- Department of Nursing, Hunan Children's Hospital, Changsha, China
| | - Tingwei Luo
- Department of Nursing, Hunan University of Chinese Medicine, Changsha, China
| | - Yuqiong Xiang
- Department of Nursing, Hunan University of Chinese Medicine, Changsha, China
| | - Sishan Jiang
- Department of Nursing, Hunan University of Chinese Medicine, Changsha, China
| | - Zhiqiang Zhang
- Department of Nursing, Hunan University of Chinese Medicine, Changsha, China
| | - Muhua Chen
- Department of Neonatology, Hunan Children's Hospital, Changsha, China
| | - Yuee Xiong
- Department of Neonatology, Hunan Children's Hospital, Changsha, China
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López-García M, Rubio L, Martin-de-Las-Heras S, Suárez J, Pérez-Cárceles MD, Martin-Martin J. Instruments to measure skills and knowledge of physicians and medical students in palliative care: A systematic review of psychometric properties. MEDICAL TEACHER 2022; 44:1133-1145. [PMID: 35486883 DOI: 10.1080/0142159x.2022.2067033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Palliative care is constantly increasing around the world. The knowledge and skills of future physicians in this area are crucial. This study evaluates the psychometric properties of knowledge and skills questionnaires used in palliative care, validated by physicians or medical students based on the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. METHODS A systematic review was carried out in Cosmin Databases, Cochrane Library, PsycINFO, SciELO, Cinahl, and Medline up to September 2020 (updated June 2021), based on the COSMIN methodology and PRISMA recommendations. The psychometric properties of each included questionnaire were identified. Methodological quality, quality of results, and quality of evidence were evaluated. RESULTS The search strategy yielded 12 questionnaires assessing the knowledge and skills of physicians or medical students. The Palliative Care Knowledge Questionnaire for PEACE (PEACE-Q) and Palliative Care Knowledge Test (PCKT) were the instruments with the highest scores for methodological quality, quality of results, and quality of evidence-based on the COSMIN methodology. CONCLUSIONS PEACE-Q and PCKT should be the preferred choice to assess palliative care knowledge and skills in physicians. In-depth studies following COSMIN validation criteria are recommended to improve the psychometric properties and cross-cultural validation of the questionnaires.
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Affiliation(s)
- Mónica López-García
- Cudeca Hospice (Palliative Care Foundation), Málaga, Spain
- Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
| | - Leticia Rubio
- Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
- Department of Legal Medicine, Facultad de Medicina, Universidad de Málaga, Málaga, Spain
| | - Stella Martin-de-Las-Heras
- Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
- Department of Legal Medicine, Facultad de Medicina, Universidad de Málaga, Málaga, Spain
| | - Juan Suárez
- Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
- Department of Legal Medicine, Facultad de Medicina, Universidad de Málaga, Málaga, Spain
| | - María D Pérez-Cárceles
- Department of Legal and Forensic Medicine, Faculty of Medicine, Biomedical Research Institute (IMIB-Arrixaca), University of Murcia, Murcia, Spain
| | - Jaime Martin-Martin
- Cudeca Hospice (Palliative Care Foundation), Málaga, Spain
- Department of Legal Medicine, Facultad de Medicina, Universidad de Málaga, Málaga, Spain
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Physicians' and Nurses' Knowledge in Palliative Care: Multidimensional Regression Models. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18095031. [PMID: 34068622 PMCID: PMC8126108 DOI: 10.3390/ijerph18095031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 11/17/2022]
Abstract
The increase in life expectancy has led to a growth in the number of people in need of palliative care. Health professionals must possess appropriate knowledge and skills. This study aimed to assess knowledge in palliative care through the Palliative Care Knowledge Test Spanish Version (PCKT-SV)®. A cross-sectional analytical study was conducted in 40 primary care health services. A total of 600 PCKT-SV questionnaires were distributed among health professionals; 561 of them (226 nurses and 335 physicians) were properly filled up. Sociodemographic information, education, and work experience were also recorded. A total of 34.41% of the nurses and 67.40% of the physicians showed good or excellent knowledge of palliative care. Physicians' scores for pain, dyspnea, and psychiatric disorders were higher than those of the nurses. Nurses scored significantly better in philosophy. Professionals with continuous training in palliative care showed a higher level of knowledge. Age and work experience of physicians and undergraduate training in nurses had significant weight in knowledge. Developing continuous training and enhancing undergraduate training in palliative care will lead to improved patient care at the end of life.
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