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Muhammed A, Dodd A, Guerin S, Delaney S, Dodd P. Complicated grief knowledge and practice: a qualitative study of general practitioners in Ireland. Ir J Psychol Med 2023; 40:330-335. [PMID: 33478613 DOI: 10.1017/ipm.2020.122] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Complicated grief is a debilitating condition that individuals may experience after losing a loved one. General practitioners (GPs) are well positioned to provide patients with support for grief-related issues. Traditionally, Irish GPs play an important role in providing patients with emotional support regarding bereavement. However, GPs have commonly reported not being aptly trained to respond to bereavement-related issues. This study explores GPs' current knowledge of and practice regarding complicated grief. METHODS A qualitative study adopting a phenomenological approach to explore the experiences of GPs on this issue. Semi-structured interviews were carried out with a purposive sample of nine GPs (five men and four women) in Ireland. Potential participants were contacted via email and phone. Interviews were audio-recorded, transcribed and analysed using Braun & Clarke's () model of thematic analysis. RESULTS GPs had limited awareness of the concept of complicated grief and were unfamiliar with relevant research. They also reported that their training was either non-existent or outdated. GPs formed their own knowledge of grief-related issues based on their intuition and experiences. For these reasons, there was not one agreed method of how to respond to grief-related issues reported by patients, though participants recognised the need for intervention, onward referral and review. CONCLUSIONS The research highlighted that GPs felt they required training in complicated grief so that they would be better able to identify and respond to complicated grief.
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Affiliation(s)
- Abiola Muhammed
- UCD School of Psychology, University College Dublin, Dublin, Ireland
| | - Anne Dodd
- UCD School of Psychology, University College Dublin, Dublin, Ireland
| | - Suzanne Guerin
- UCD School of Psychology, University College Dublin, Dublin, Ireland
| | | | - Philip Dodd
- UCD School of Psychology, University College Dublin, Dublin, Ireland
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Supporting bereavement and complicated grief in primary care: a realist review. BJGP Open 2021; 5:BJGPO.2021.0008. [PMID: 33653707 PMCID: PMC8278512 DOI: 10.3399/bjgpo.2021.0008] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 02/18/2021] [Indexed: 12/03/2022] Open
Abstract
Background Bereavement can have significant impacts on physical and mental health, and a minority of people experience complicated and prolonged grief responses. Primary care is ideally situated to offer bereavement care, yet UK provision remains variable and practitioners feel uncertain how best to support bereaved patients. Aim To identify what works, how, and for whom, in the management of complicated grief (CG) in primary care. Design & setting A review of evidence on the management of CG and bereavement in UK primary care settings. Method A realist approach was taken that aims to provide causal explanations through the generation and articulation of contexts, mechanisms, and outcomes. Results Forty-two articles were included. Evidence on the primary care management of complicated or prolonged grief was limited. GPs and nurses view bereavement support as part of their role, yet experience uncertainty over the appropriate extent of their involvement. Patients and clinicians often have differing views on the role of primary care in bereavement. Training in bereavement, local systems for reporting deaths, practitioner time, and resources can assist or hinder bereavement care provision. Practitioners find bereavement care can be emotionally challenging. Understanding patients’ needs can encourage a proactive response and help identify appropriate support. Conclusion Bereavement care in primary care remains variable and practitioners feel unprepared to provide appropriate bereavement care. Patients at higher risk of complicated or prolonged grief may fail to receive the support they need from primary care. Further research is required to address the potential unmet needs of bereaved patients.
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Schwill S, Reith D, Walter T, Engeser P, Wensing M, Flum E, Szecsenyi J, Krug K. How to ensure basic competencies in end of life care - a mixed methods study with post-graduate trainees in primary care in Germany. BMC Palliat Care 2020; 19:36. [PMID: 32209073 PMCID: PMC7093985 DOI: 10.1186/s12904-020-00540-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 03/09/2020] [Indexed: 11/12/2022] Open
Abstract
Background Providing end of life care (EoLC) is an important aspect of primary care, which reduces the risk of hospital admission for most patients. However, general practitioners (GPs) seem to have low confidence in their ability to provide EoLC. Little is known about an adequate volume and kind of training in EoLC among GP trainees. Methods We performed a before-after comparison in all post-graduate GP trainees who were registered in the vocational training program (KWBW VerbundweiterbildungPLUS). They were offered participation within a two-day seminar focussing on palliative care in 2017. Those who attended the seminar (intervention group I) completed a paper-based questionnaire directly before the intervention (T1) and 6 months after (T2). None-attendees (group C) were also asked to fill out the questionnaire once. The questionnaire covered previous experiences in palliative care, self-assessment of competencies in EoLC in the organisation of patient care as well as in control of symptoms, attitudes towards death and caring for dying patients and questions about GPs’ role in EoLC. Results In total, 294 GP trainees (I: n = 219; C: n = 75) participated in the study. Of those, more than 90% had previously gained experience in EoLC mainly during vocational training in the hospital rotation. Around a third had previously gained competencies in EoLC in medical school. Between groups I (T1) and C no significant differences were observed in socio-demographic characteristics, pre-existing experience or overall expertise. At T2, 75% of participants of group I declared they have extended their competencies in EoLC after the intervention and 70% classified the intervention as helpful or very helpful. Overall, they rated their competencies significantly higher than at T1 (p < 0.01). In detail, competencies in organisation of EoLC and competencies in handling of symptoms significantly improved (p < 0.01). Due to the intervention, 66% could reflect their attitudes towards dying, death and grief and 18% changed their attitudes. Group I highlighted palliative care as one of GPs tasks (Likert 4.47/5, SD 0.75). Conclusions The intervention fostered personal competencies, understanding and self-confidence in EoLC among GP trainees. This is crucial for the aim to broadly provide EoLC.
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Affiliation(s)
- Simon Schwill
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Marsilius Arkaden, INF 130.3, Turm West, 69120, Heidelberg, Germany.
| | - Dorothee Reith
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Marsilius Arkaden, INF 130.3, Turm West, 69120, Heidelberg, Germany
| | - Tobias Walter
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Marsilius Arkaden, INF 130.3, Turm West, 69120, Heidelberg, Germany
| | - Peter Engeser
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Marsilius Arkaden, INF 130.3, Turm West, 69120, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Marsilius Arkaden, INF 130.3, Turm West, 69120, Heidelberg, Germany
| | - Elisabeth Flum
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Marsilius Arkaden, INF 130.3, Turm West, 69120, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Marsilius Arkaden, INF 130.3, Turm West, 69120, Heidelberg, Germany
| | - Katja Krug
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Marsilius Arkaden, INF 130.3, Turm West, 69120, Heidelberg, Germany
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Morris S, Schaefer K, Rosowsky E. Primary Care for the Elderly Bereaved: Recommendations for Medical Education. J Clin Psychol Med Settings 2019; 25:463-470. [PMID: 29500657 DOI: 10.1007/s10880-018-9556-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The aim of this study was to explore the current practices of primary care physicians (PCPs) in providing bereavement care to elderly patients, with implications for medical education. A total of 63 PCPs answered a brief online survey about their typical practices, barriers, comfort level with bereavement, and confidence in their ability to diagnose prolonged grief disorder (PGD). They were recruited through an online newsletter and contacts of one of the authors. The results found that two-thirds of the PCPs do not routinely screen their elderly patients for recent losses, nor do they refer to mental health clinicians when loss is identified. Barriers included not learning of the deaths in patients' lives and lack of time during clinic visits. Those PCPs who had experienced their own losses were significantly more comfortable in speaking to patients about recent losses and more confident in their ability to diagnose PGD. We recommend bereavement education be incorporated into the medical school curriculum from the outset, utilizing the psychological principle of graded exposure to bereaved individuals.
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Affiliation(s)
- Sue Morris
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston Children's Hospital and Brigham and Women's Hospital, Harvard Medical School, 450 Brookline Avenue, DA 2016A, Boston, MA, 02215, USA.
| | - Kristen Schaefer
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Selman LE, Brighton LJ, Robinson V, George R, Khan SA, Burman R, Koffman J. Primary care physicians' educational needs and learning preferences in end of life care: A focus group study in the UK. BMC Palliat Care 2017; 16:17. [PMID: 28274216 PMCID: PMC5343378 DOI: 10.1186/s12904-017-0191-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 02/17/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary care physicians (General Practitioners (GPs)) play a pivotal role in providing end of life care (EoLC). However, many lack confidence in this area, and the quality of EoLC by GPs can be problematic. Evidence regarding educational needs, learning preferences and the acceptability of evaluation methods is needed to inform the development and testing of EoLC education. This study therefore aimed to explore GPs' EoLC educational needs and preferences for learning and evaluation. METHODS A qualitative focus group study was conducted with qualified GPs and GP trainees in the UK. Audio recordings were transcribed and analysed thematically. Expert review of the coding frame and dual coding of transcripts maximised rigour. RESULTS Twenty-eight GPs (10 fully qualified, 18 trainees) participated in five focus groups. Four major themes emerged: (1) why education is needed, (2) perceived educational needs, (3) learning preferences, and (4) evaluation preferences. EoLC was perceived as emotionally and clinically challenging. Educational needs included: identifying patients for palliative care; responsibilities and teamwork; out-of-hours care; having difficult conversations; symptom management; non-malignant conditions; and paediatric palliative care. Participants preferred learning through experience, working alongside specialist palliative care staff, and discussion of real cases, to didactic methods and e-learning. 360° appraisals and behavioural assessment using videoing or simulated interactions were considered problematic. Self-assessment questionnaires and patient and family outcome measures were acceptable, if used and interpreted correctly. CONCLUSIONS GPs require education and support in EoLC, particularly the management of complex clinical care and counselling. GPs value mentoring, peer-support, and experiential learning alongside EoLC specialists over formal training.
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Affiliation(s)
- Lucy Ellen Selman
- University of Bristol, School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Lisa Jane Brighton
- King's College London, Cicely Saunders Institute, Bessemer Road, Denmark Hill, London, SE59PJ, UK
| | - Vicky Robinson
- King's College London, Cicely Saunders Institute, Bessemer Road, Denmark Hill, London, SE59PJ, UK
| | - Rob George
- King's College London, Cicely Saunders Institute, Bessemer Road, Denmark Hill, London, SE59PJ, UK.,St Christopher's Hospice, 51-59 Lawrie Park Road, London, SE26 6DZ, UK
| | - Shaheen A Khan
- Guy's & St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE19RT, UK
| | - Rachel Burman
- King's College Hospital NHS Foundation Trust, Bessemer Road, Denmark Hill, London, SE5 9RS, UK
| | - Jonathan Koffman
- King's College London, Cicely Saunders Institute, Bessemer Road, Denmark Hill, London, SE59PJ, UK
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Magee C, Koffman J. Out-of-hours palliative care: what are the educational needs and preferences of general practitioners? BMJ Support Palliat Care 2015; 6:362-8. [DOI: 10.1136/bmjspcare-2014-000764] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 02/17/2015] [Indexed: 11/04/2022]
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Ghesquiere AR, Patel SR, Kaplan DB, Bruce ML. Primary care providers' bereavement care practices: recommendations for research directions. Int J Geriatr Psychiatry 2014; 29:1221-9. [PMID: 24955568 PMCID: PMC4418789 DOI: 10.1002/gps.4157] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 05/17/2014] [Accepted: 05/21/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Bereaved patients are often seen in primary care settings. Although most do not require formal support, physicians may be called upon to provide support to some bereaved, particularly those with bereavement-related mental health disorders like complicated grief and bereavement-related depression. Research evidence on physician bereavement care is scant. We make recommendations for future research in this area. DESIGN Literature review focuses on studies conducted between 1996 and 2013 in the United States. Searches of Medline and PsychInfo, along with hand searches of reference sections, were conducted. RESULTS The limited existing research indicates substantial gaps in the research literature, especially in the areas of primary care physician skill and capacity, patient-level outcomes, and the quality of research methodology. No US studies have focused specifically on care for bereavement-related mental health disorders. We provide recommendations about how to improve research about primary care bereavement care. CONCLUSIONS The primary care sector offers ample opportunities for research on bereavement care. With greater research efforts, there may be improvements to quality of bereavement care in primary care, in general, and also to the accurate detection and appropriate referral for bereavement-related mental health conditions.
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Affiliation(s)
| | - Sapana R. Patel
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University and the New York State Psychiatric Institute
| | - Daniel B. Kaplan
- Department of Geriatric Psychiatry, Weill Cornell Medical College
| | - Martha L. Bruce
- Department of Geriatric Psychiatry, Weill Cornell Medical College
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Pype P, Peersman W, Wens J, Stes A, Van den Eynden B, Deveugele M. What, how and from whom do health care professionals learn during collaboration in palliative home care: a cross-sectional study in primary palliative care. BMC Health Serv Res 2014; 14:501. [PMID: 25377856 PMCID: PMC4226882 DOI: 10.1186/s12913-014-0501-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 10/06/2014] [Indexed: 11/27/2022] Open
Abstract
Background Palliative care often requires inter-professional collaboration, offering opportunities to learn from each other. General practitioners often collaborate with specialized palliative home care teams. This study seeks to identify what, how and from whom health care professionals learn during this collaboration. Methods Cross-sectional survey in Belgium. All palliative home care teams were invited to participate. General practitioners (n = 267) and palliative care nurses (n = 73) filled in questionnaires. Results General practitioners (GPs) and palliative care nurses learned on all palliative care aspects. Different learning activities were used. Participants learned from all others involved in patient care. The professionals’ discipline influences the content, the way of learning and who learns from whom. Multiple linear regression shows significant but limited association of gender with amount of learning by GPs (M < F; p = 0.042; Adj R2 = 0.07) and nurses (M > F; p = 0.019; Adj R2 = 0.01). Conclusions This study is the first to reveal what, how and from whom learning occurs during collaboration in palliative care. Training professionals in sharing expertise during practice and in detecting and adequately responding to others’ learning needs, could optimize this way of learning. Electronic supplementary material The online version of this article (doi:10.1186/s12913-014-0501-9) contains supplementary material, which is available to authorized users.
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Slort W, Blankenstein AH, Schweitzer BPM, Deliens L, van der Horst HE. Effectiveness of the 'availability, current issues and anticipation' (ACA) training programme for general practice trainees on communication with palliative care patients: a controlled trial. PATIENT EDUCATION AND COUNSELING 2014; 95:83-90. [PMID: 24412094 DOI: 10.1016/j.pec.2013.12.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 11/27/2013] [Accepted: 12/10/2013] [Indexed: 05/17/2023]
Abstract
OBJECTIVE This study aimed to evaluate the effectiveness of a new palliative care 'availability, current issues and anticipation' (ACA) training programme to improve communication skills of general practice trainees (GPTs). METHODS In a controlled trial among third-year GPTs, we videotaped one 20-min consultation between each GPT and a simulated palliative care patient at baseline and at six months follow-up. We measured the number of issues discussed and the quality of communication skills and analysed between-group differences using linear mixed models and logistic regression. RESULTS Fifty-four GPTs were assigned to the intervention and 64 to the control group. We found no effect of the programme on the number of issues discussed or on the quality of GPT communicative behaviour. GPTs infrequently addressed 'spiritual/existential issues' and 'unfinished business'. In a selection of the consultations, simulated patients brought up more issues than the GPTs did. CONCLUSION The ACA training programme was not effective in the way it was carried out and evaluated in this trial. PRACTICE IMPLICATIONS The ACA programme should focus on the issues that scored low in this trial. Future research on GPT-patient communication in palliative care should consider using real patients in a series of consultations to evaluate effectiveness.
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Affiliation(s)
- Willemjan Slort
- Department of General Practice & Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
| | - Annette H Blankenstein
- Department of General Practice & Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Bart P M Schweitzer
- Department of General Practice & Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Luc Deliens
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
| | - Henriëtte E van der Horst
- Department of General Practice & Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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O’Connor M, Breen LJ. General Practitioners' experiences of bereavement care and their educational support needs: a qualitative study. BMC MEDICAL EDUCATION 2014; 14:59. [PMID: 24670040 PMCID: PMC3986890 DOI: 10.1186/1472-6920-14-59] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 03/17/2014] [Indexed: 05/28/2023]
Abstract
BACKGROUND General Practitioners (GPs) are well-positioned to provide grief support to patients. Most GPs view the provision of bereavement care as an important aspect of their role and the GP is the health professional that many people turn to when they need support. We aimed to explore GPs' understandings of bereavement care and their education and professional development needs in relation to bereavement care. METHODS An in-depth qualitative design was adopted using a social constructionist approach as our aims were exploratory and applied. Nineteen GPs (12 women and 7 men) living in Western Australia were interviewed; 14 were based in metropolitan Perth and 5 in rural areas. GPs were invited, via a letter, to participate in a semi-structured interview. The interviews occurred within each GP's workplace or, for the rural GPs, via telephone, and all interviews were digitally audio-recorded and transcribed. RESULTS Analysis was based upon constant comparison and began as soon as possible after each interview. The data revealed four tensions or opposing views concerning bereavement and bereavement care. These were (1) whether grief is a standardised versus an individual process, (2) the role of the GP in intervening versus promoting resilience, (3) the GP as a broker of services versus a service provider, and (4) the need for formal education and professional development versus 'on-the-job' experiential learning. CONCLUSIONS GPs have a critical role in exploring distress, including grief. However, changes need to be made to ensure GPs have up-to-date knowledge of contemporary theories and approaches. GPs urgently need education both at the undergraduate and postgraduate degree levels, and in continuing professional development. Otherwise GPs will rely on out-dated theories and constructions of grief, which may be detrimental to patient care.
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Affiliation(s)
- Moira O’Connor
- School of Psychology and Speech Pathology, Faculty of Health Sciences, Curtin University, Perth, WA Australia
| | - Lauren J Breen
- School of Psychology and Speech Pathology, Faculty of Health Sciences, Curtin University, Perth, WA Australia
- School of Psychology and Social Science, Edith Cowan University, Perth, WA Australia
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Momen N, Hadfield P, Harrison K, Barclay S. Managing pain in advanced cancer: a survey of United kingdom general practitioners and community nurses. J Pain Symptom Manage 2013. [PMID: 23195390 DOI: 10.1016/j.jpainsymman.2012.09.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
CONTEXT General practitioners (GPs) and community nurses (CNs) have a central role in palliative care. With health policy focusing more and more on enabling patients to die at home, primary health care professionals are increasingly responsible for symptom management of patients near the end of life. OBJECTIVES 1) To investigate GPs' and CNs' training and knowledge in palliative care and 2) to identify the characteristics of GPs and CNs with lower levels of palliative care knowledge. METHODS A postal questionnaire was sent to all GPs and CNs in two areas of the U.K. A panel of doctors and nurses with palliative care expertise rated the response categories with regard to correctness and questions with regard to importance for their professional group. These weightings were combined and applied to answers to assess knowledge levels. RESULTS Response rates were 54% and 35% for GPs and CNs, respectively. Respondents reported receiving training in most areas of palliative care throughout their careers, with the exceptions of syringe driver use and bereavement care. High levels of knowledge concerning pain management and syringe driver use were found, with no significant differences in the overall knowledge between the professions. Some important gaps were identified for future educational focus. Regression analyses did not identify characteristics that explained the variation in knowledge scores. CONCLUSION Both groups had a high level of knowledge concerning key issues in pain management and syringe driver use that should equip them well for their central role in palliative care. Recommendations for the focus of future education sessions are made.
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Affiliation(s)
- Natalie Momen
- Institute of Public Health, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
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Breen LJ, Fernandez M, O'Connor M, Pember AJ. The preparation of graduate health professionals for working with bereaved clients: an Australian perspective. OMEGA-JOURNAL OF DEATH AND DYING 2013; 66:313-32. [PMID: 23785983 DOI: 10.2190/om.66.4.c] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Students enrolled in health profession courses require grief education so that, upon graduation, they are able to meet the needs of clients living with loss and grief. We investigated grief and loss education in six Australian university programs--medicine, nursing, counseling, psychology, social work, and occupational therapy--drawing from course documents and face-to-face interviews with key staff and final-year students. Only the counseling course included a dedicated grief and loss unit. The nursing, medicine, and occupational therapy courses emphasized end-of-life issues rather than a breadth of bereavement experiences. The social work course taught grief as a socially-constructed practice and the psychology course focused on grief and loss in addiction. Several factors influenced the delivery of grief education, including staffing, time, placement opportunities, student feedback, and needs of each profession. The study provides an indication as to how future health professionals are prepared for grief and loss issues in their practice.
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Affiliation(s)
- Lauren J Breen
- School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia.
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13
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Slort W, Blankenstein AH, Schweitzer BPM, Knol DL, Deliens L, Aaronson NK, van der Horst HE. Effectiveness of the ACA (Availability, Current issues and Anticipation) training programme on GP-patient communication in palliative care; a controlled trial. BMC FAMILY PRACTICE 2013; 14:93. [PMID: 23819723 PMCID: PMC3734100 DOI: 10.1186/1471-2296-14-93] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 05/07/2013] [Indexed: 01/28/2023]
Abstract
Background Communicating effectively with palliative care patients has been acknowledged to be somewhat difficult, but little is known about the effect that training general practitioners (GPs) in specific elements of communication in palliative care might have. We hypothesized that GPs exposed to a new training programme in GP-patient communication in palliative care focusing on availability of the GP for the patient, current issues the GP should discuss with the patient and anticipation by the GP of various scenarios (ACA), would discuss more issues and become more skilled in their communication with palliative care patients. Methods In this controlled trial among GPs who attended a two-year Palliative Care Peer Group Training Course in the Netherlands only intervention GPs received the ACA training programme. To evaluate the effect of the programme a content analysis (Roter Interaction Analysis System) was performed of one videotaped 15-minute consultation of each GP with a simulated palliative care patient conducted at baseline, and one at 12 months follow-up. Both how the GP communicated with the patient (‘availability’) and the number of current and anticipated issues the GP discussed with the patient were measured quantitatively. We used linear mixed models and logistic regression models to evaluate between-group differences over time. Results Sixty-two GPs were assigned to the intervention and 64 to the control group. We found no effect of the ACA training programme on how the GPs communicated with the patient or on the number of issues discussed by GPs with the patient. The total number of issues discussed by the GPs was eight out of 13 before and after the training in both groups. Conclusion The ACA training programme did not influence how the GPs communicated with the simulated palliative care patient or the number of issues discussed by the GPs in this trial. Further research should evaluate whether this training programme is effective for GPs who do not have a special interest in palliative care and whether studies using outcomes at patient level can provide more insight into the effectiveness of the ACA training programme. Trial registration Current Controlled Trials ISRCTN56722368
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Affiliation(s)
- Willemjan Slort
- Department of General Practice & Elderly Care Medicine, EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
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Oya H, Matoba M, Murakami S, Ohshiro T, Kishino T, Satoh Y, Tsukahara T, Hori S, Maeda M, Makino T, Maeda T. Mandatory palliative care education for surgical residents: initial focus on teaching pain management. Jpn J Clin Oncol 2012; 43:170-5. [PMID: 23275645 PMCID: PMC3559015 DOI: 10.1093/jjco/hys205] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Knowledge concerning palliative care and the associated skills, including effective pain control, is essential for surgeons who treat cancer patients in daily practice. This study focuses on a palliative care training course that has been mandatorily conducted for all surgical residents of our hospital since 2009. METHODS We evaluated the effectiveness of our mandatory palliative care training course by conducting a retrospective study of the patients' medical records and participants' questionnaire results and discussed the importance of palliative care education for surgical residents. RESULTS All 12 surgical residents who participated in the course in 2009 had graduated 4-9 years back. They were assigned to look after a total of 92 cases (average, 7.66 cases per resident) during the course. The purpose of care in most cases (92.3%) was to mitigate pain. Introducing analgesic adjuvants such as gabapentin or amitriptyline accounted for the largest part of initial interventions (23.9%) aimed at controlling cancer pain, followed by changes in route of administration or doses of prior opioid analgesics (21.7%). Interventions with opioid analgesics were conducted most frequently (47.7%). The overall pain improvement rate was 89.1%. We used a questionnaire after the course to evaluate its effectiveness. CONCLUSIONS The surgical residents stated that it was a meaningful course through which they gained practical knowledge on palliative care and that the experience would change their approach to home care.
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Affiliation(s)
- Hisaharu Oya
- Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
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Nagraj S, Barclay S. Bereavement care in primary care: a systematic literature review and narrative synthesis. Br J Gen Pract 2011; 61:e42-8. [PMID: 21401990 PMCID: PMC3020071 DOI: 10.3399/bjgp11x549009] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Revised: 04/21/2010] [Accepted: 04/27/2010] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Over half a million people die in Britain each year and, on average, a GP will have 20 patients die annually. Bereavement is associated with significant morbidity and mortality, but the research evidence on which GPs and district nurses can base their practice is limited. AIM To review the existing literature concerning how GPs and district nurses think they should care for patients who are bereaved and how they do care for them. design systematic literature review. METHOD Searches of AMED, BNI, CINAHL, EMBASE, Medline and PsychInfo databases were undertaken, with citation searches of key papers and hand searches of two journals. Inclusion criteria were studies containing empirical data relating to adult bereavement care provided by GPs and district nurses. Information from data extraction forms were analysed using NVivo software, with a narrative synthesis of emergent themes. RESULTS Eleven papers relating to GPs and two relating to district nurses were included. Both groups viewed bereavement care as an important and satisfying part of their work, for which they had received little training. They were anxious not to 'medicalise' normal grief. Home visits, telephone consultations, and condolence letters were all used in their support of bereaved people. CONCLUSION A small number of studies were identified, most of which were > 10 years old, from single GP practices, or small in size and of limited quality. Although GPs and district nurses stated a preference to care for those who were bereaved in a proactive fashion, little is known of the extent to which this takes place in current practice, or the content of such care.
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Affiliation(s)
- Shobhana Nagraj
- General Practice and Primary Care Research Unit, Department of Public Health and Primary Care, Institute of Public Health, Cambridge
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16
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Charlton R, Currie A. A UK Perspective on Worldwide Inadequacies in Palliative Care Training: A Short Postgraduate Course Is Proposed. Am J Hosp Palliat Care 2008; 25:63-71. [DOI: 10.1177/1049909107307389] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A chronological literature review illustrates how undergraduate and postgraduate education and training in the care of the dying and bereaved is inadequate worldwide. This is despite the foundation of the modern hospice movement in the United Kingdom in 1967 and its wider dissemination as a specialty in 1985. This situation has implications for those doctors working in both primary and secondary care, and this paper describes a 3-day course which has been successfully run in the West Midlands, UK, since 1997 for family physicians in training. A pre-course survey of 250, with a response rate of 54%, in 2003 revealed that 100% of respondents felt that they needed further training, and 51.5% said that they had had no previous training in palliative care.
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