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Bansal N, Jeewa A, Watanabe K, Richmond ME, Alzubi A, D'Souza N, Bano M, Lorts A, Rosenthal DN, Taylor K, O'Shea C, Smyth L, Koehl D, Zhao H, Hollander SA. Reducing donor acceptance practice variation - Learnings from a discussion forum. Pediatr Transplant 2024; 28:e14635. [PMID: 37957127 DOI: 10.1111/petr.14635] [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] [Received: 06/15/2023] [Revised: 09/26/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE Although waitlist mortality is unacceptably high, nearly half of donor heart offers are rejected by pediatric heart transplant centers. The Advanced Cardiac Therapy Improving Outcome Network (ACTION) and Pediatric Heart Transplant Society (PHTS) convened a multi-institutional donor decision discussion forum (DDDF) aimed at assessing donor acceptance practices and reducing practice variation. METHODS A 1-h-long virtual DDDF for providers across North America, the United Kingdom, and Brazil was held monthly. Each session typically included two case presentations posing a real-world donor decision challenge. Attendees were polled before the presenting center's decision was revealed. Group discussion followed, including a review of relevant literature and PHTS data. Metrics of participation, participant agreement with presenting center decisions, and impact on future decision-making were collected and analyzed. RESULTS Over 2 years, 41 cases were discussed. Approximately 50 clinicians attended each call. Risk factors influencing decision-making included donor quality (10), size discrepancy (8), and COVID-19 (8). Donor characteristics influenced 63% of decisions, recipient factors 35%. Participants agreed with the decision made by the presenting center only 49% of the time. Post-presentation discussion resulted in 25% of participants changing their original decision. Survey conducted reported that 50% respondents changed their donor acceptance practices. CONCLUSION DDDF identified significant variation in pediatric donor decision-making among centers. DDDF may be an effective format to reduce practice variation, provide education to decision-makers, and ultimately increase donor utilization.
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Affiliation(s)
- Neha Bansal
- Icahn School of Medicine at Mount Sinai, Mount Sinai Kravis Children's Hospital, New York, New York, USA
| | - Aamir Jeewa
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kae Watanabe
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Marc E Richmond
- Division of Pediatric Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Anaam Alzubi
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Nikita D'Souza
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Maria Bano
- Department of Pediatric Cardiology, UT Southwestern, Dallas, Texas, USA
| | - Angela Lorts
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | | | | | - Lauren Smyth
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Hong Zhao
- Kirklin Solutions, Hoover, Alabama, USA
| | - Seth A Hollander
- Stanford University School of Medicine, Palo Alto, California, USA
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Paul TK, Aglio T, Dalgo A, Kaye EC. Narrative Medicine in Hospice and Palliative Care: A Longitudinal Fellowship Curriculum Pilot. Am J Hosp Palliat Care 2023:10499091231223717. [PMID: 38128066 PMCID: PMC11190033 DOI: 10.1177/10499091231223717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION Growing evidence suggests that clinician exposure to narrative medicine (NM) may help bolster resilience and mitigate burnout. The value of formal longitudinal training in NM for hospice and palliative medicine (HPM) trainees remains understudied. METHODS A 1-year longitudinal NM curriculum for HPM fellows was pilot-tested for feasibility, acceptability, and exploratory impact. Six monthly 45-minute sessions included reading literature, reflective writing, and sharing creative work. Quantitative and qualitative data were collected through a pre-intervention survey and post-intervention survey administered immediately upon completion of the curriculum. Longitudinal impact was assessed with a post-intervention survey administered three months after completion of the curriculum. RESULTS All HPM fellows (n = 6) attended at least 5/6 sessions during the 1-year pilot, suggesting intervention feasibility. Participant engagement and self-reported comfort with NM exercises supported intervention acceptability. Post-intervention, participants described the positive influence of NM practice on their clinical practice and stated an intention to integrate NM skills in their future HPM careers. Three months following the intervention, participants had a sustained increase in their comfort level with NM. All participants felt that the NM sessions had been relevant to their life as HPM fellows and anticipated using NM moving forward in their practice of HPM. DISCUSSION This novel NM curriculum was feasible and acceptable to implement in a 1-year HPM fellowship. Longitudinal impact showed sustained increase in trainee comfort and interest in using NM in their future clinical practice.
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Affiliation(s)
| | - Taylor Aglio
- Connecticut Children’s Medical Center, Hartford, CT, USA
- University of Connecticut School of Medicine, Memphis, TN, USA
| | - Austin Dalgo
- Le Bonheur Children’s Hospital, Memphis, TN, USA
- University of Tennessee Health Sciences Center, Memphis, TN, USA
| | - Erica C. Kaye
- St. Jude Children’s Research Hospital, Memphis, TN, USA
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Trahair ED, Mantri S. Examining the Role of Narrative in Palliative Care for Parkinson Disease: Changing the Story. Neurol Clin Pract 2023; 13:e200150. [PMID: 37081942 PMCID: PMC10112858 DOI: 10.1212/cpj.0000000000200150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/10/2023] [Indexed: 04/22/2023]
Abstract
Recent years have seen growing interest in neuropalliative care as a subspecialty. Simultaneously, the rise of narrative medicine in patient support groups and clinician training programs offers a way to listen deeply to the stories of those living with chronic illness and may inform corresponding health interventions. This commentary examines the ways in which an understanding of illness narrative schemata, particularly the so-called "chaos narrative," can contribute to patient and care partner distress, which in turn can be alleviated by a palliative care approach. Through examples of stories of people with Parkinson disease and their care partners, the article emphasizes the intersections between narrative medicine, neurology, and palliative care. Specific opportunities for bringing narrative medicine into the clinic are discussed.
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Affiliation(s)
- Esme D Trahair
- Department of Neurology (EDT, SM); and Trent Center for Bioethics, Humanities, and History of Medicine (EDT, SM), Duke University School of Medicine, Durham, NC
| | - Sneha Mantri
- Department of Neurology (EDT, SM); and Trent Center for Bioethics, Humanities, and History of Medicine (EDT, SM), Duke University School of Medicine, Durham, NC
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Hasselmo S, Thomas I, Páez J, Kowalski S, Cardona L, Martin A. A Hero's Journey: Supporting children throughout inpatient psychiatric hospitalization using a therapeutic comic book. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2023. [PMID: 37060163 DOI: 10.1111/jcap.12415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 03/21/2023] [Accepted: 03/26/2023] [Indexed: 04/16/2023]
Abstract
PROBLEM Art- and narrative-based interventions are an integral component of pediatric inpatient psychiatric care. We describe a novel therapeutic comic book we developed for hospitalized children and young adolescents. METHODS A Hero's Journey is a 38-page zine that can be freely downloaded and photocopied for distribution. The short booklet is intended to demystify and offer guidance throughout the experience of hospitalization, promote interaction and socialization, provide scaffolding for skill-building, and prepare patients for moving forward after discharge. FINDINGS The underlying foundations of the booklet include: 1) Theoretical sources (Joseph Campbell's hero's journey; Donald Schön's reflective practice; and the principles of narrative medicine); and 2) Clinical sources (collaborative problem solving; cognitive-behavioral therapy, and trauma-informed care). We articulate how each page relates to the different components, and how individual pages can be used as worksheets for practice of specific skills. We next provide suggestions on how best to use the booklet: from arrival at the emergency room, through inpatient hospitalization, and toward discharge. We also propose ways for staff, caregivers, and any child-facing adult to make use of this clinical resource in support of a patient's recovery and reintegration into their community. CONCLUSIONS Even though not yet empirically tested, this therapeutic comic book is available for dissemination free of cost. We encourage leaders in nursing and therapeutic recreation to try using this resource in their emergency room and milieu settings.
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Affiliation(s)
| | - Isaiah Thomas
- Yale School of Medicine, New Haven, Connecticut, USA
| | - José Páez
- Yale School of Medicine, New Haven, Connecticut, USA
- Child Study Center, Yale School of Medicine New Haven, New Haven, Connecticut, USA
- Children's Psychiatric Inpatient Service, Yale-New Haven Hospital, New Haven, Connecticut, USA
| | - Sarah Kowalski
- Children's Psychiatric Inpatient Service, Yale-New Haven Hospital, New Haven, Connecticut, USA
| | - Laurie Cardona
- Yale School of Medicine, New Haven, Connecticut, USA
- Child Study Center, Yale School of Medicine New Haven, New Haven, Connecticut, USA
- Children's Psychiatric Inpatient Service, Yale-New Haven Hospital, New Haven, Connecticut, USA
| | - Andrés Martin
- Yale School of Medicine, New Haven, Connecticut, USA
- Child Study Center, Yale School of Medicine New Haven, New Haven, Connecticut, USA
- Children's Psychiatric Inpatient Service, Yale-New Haven Hospital, New Haven, Connecticut, USA
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Zhao J, Xiantao O, Li Q, Liu H, Wang F, Li Q, Xu Z, Ji S, Yue S. Role of narrative medicine-based education in cultivating empathy in residents. BMC MEDICAL EDUCATION 2023; 23:124. [PMID: 36810009 PMCID: PMC9945735 DOI: 10.1186/s12909-023-04096-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To explore the role of narrative medicine-based education in standardized empathy training for residents. METHODS Among the 2018-2020 residents at the First Affiliated Hospital of Xinxiang Medical University, 230 receiving neurology training were enrolled in this study and randomly divided into study and control groups. The study group received narrative medicine-based education and standardized routine resident training. The Jefferson Scale of Empathy-Medical Student version (JSE-MS) was used to evaluate empathy in the study group, and the neurological professional knowledge test scores of the two groups were also compared. RESULTS In the study group, the empathy score was higher than the preteaching score (P < 0.01). The neurological professional knowledge examination score was higher in the study group than in the control group, albeit not significantly. CONCLUSION The addition of narrative medicine-based education in standardized training improved empathy and may have improved the professional knowledge of neurology residents.
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Affiliation(s)
- Jianhua Zhao
- Henan Joint International Research Laboratory of Neurorestoratology for Senile Dementia, Henan Key Laboratory of Neurorestoratology, Department of Neurology, First Affiliated Hospital of Xinxiang Medical University, 453100, Weihui, Xinxiang, Henan, China.
| | - Ouyang Xiantao
- Management Institute of Xinxiang Medical University, 453003, Xinxiang, Henan, China
| | - Qiong Li
- Henan Joint International Research Laboratory of Neurorestoratology for Senile Dementia, Henan Key Laboratory of Neurorestoratology, Department of Neurology, First Affiliated Hospital of Xinxiang Medical University, 453100, Weihui, Xinxiang, Henan, China
| | - Hao Liu
- Henan Joint International Research Laboratory of Neurorestoratology for Senile Dementia, Henan Key Laboratory of Neurorestoratology, Department of Neurology, First Affiliated Hospital of Xinxiang Medical University, 453100, Weihui, Xinxiang, Henan, China
| | - Fan Wang
- Henan Joint International Research Laboratory of Neurorestoratology for Senile Dementia, Henan Key Laboratory of Neurorestoratology, Department of Neurology, First Affiliated Hospital of Xinxiang Medical University, 453100, Weihui, Xinxiang, Henan, China
| | - Qing Li
- Henan Joint International Research Laboratory of Neurorestoratology for Senile Dementia, Henan Key Laboratory of Neurorestoratology, Department of Neurology, First Affiliated Hospital of Xinxiang Medical University, 453100, Weihui, Xinxiang, Henan, China
| | - Zhixiu Xu
- Henan Joint International Research Laboratory of Neurorestoratology for Senile Dementia, Henan Key Laboratory of Neurorestoratology, Department of Neurology, First Affiliated Hospital of Xinxiang Medical University, 453100, Weihui, Xinxiang, Henan, China
| | - Sibei Ji
- Henan Joint International Research Laboratory of Neurorestoratology for Senile Dementia, Henan Key Laboratory of Neurorestoratology, Department of Neurology, First Affiliated Hospital of Xinxiang Medical University, 453100, Weihui, Xinxiang, Henan, China
| | - Shuangzhu Yue
- Resident Standardized Training Center, the First Affiliated Hospital of Xinxiang Medical University, 453100, Weihui, Xinxiang, Henan, China
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Xue M, Sun H, Xue J, Zhou J, Qu J, Ji S, Bu Y, Liu Y. Narrative medicine as a teaching strategy for nursing students to developing professionalism, empathy and humanistic caring ability: a randomized controlled trial. BMC MEDICAL EDUCATION 2023; 23:38. [PMID: 36653810 PMCID: PMC9850682 DOI: 10.1186/s12909-023-04026-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 01/12/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Narrative medicine has become a solution to cultivate medical students' ability of empathy and humanistic care. However, the role of narrative medicine is lacking in the study of professionalism. The aim of this study was to analyze the effects of narrative medical theory learning and narrative writing on professionalism, empathy and humanistic care ability of nursing students. METHODS This cluster randomized controlled trial was conducted between June 2021 and June 2022 in two universities in Jiangsu, China. The participants of this study were 85 nursing students who were randomly divided into the intervention group (n = 43) or the control group (n = 42). Participants in the intervention group were trained in narrative medical theory learning and narrative writing based on a Web-based platform, while those in the control group were not. Self-report questionnaires of professionalism, empathy and humanistic care ability were used before and after intervention. RESULTS The results showed that the professionalism score of the intervention group was (68.7 ± 6.8 vs. 64.5 ± 7.5; P = 0.005), empathy (99.4 ± 15.7 vs. 92.2 ± 14.6; P = 0.014) and humanistic care ability (127.6 ± 20.0 vs. 113.3 ± 18.8; P = 0.004) were better than the control group. CONCLUSION The results of this quantitative study suggest that narrative medical theory education and narrative writing based on the network platform can promote the development of professionalism, empathy and humanistic care ability of nursing undergraduates.
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Affiliation(s)
- Mengxin Xue
- School of Nursing and Public Health, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Huiping Sun
- School of Nursing and Public Health, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Jin Xue
- Guangling College, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Jingxin Zhou
- School of Nursing and Public Health, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Junchao Qu
- School of Nursing and Public Health, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Siqi Ji
- School of Nursing and Public Health, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Yuan Bu
- School of Nursing and Public Health, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Yongbing Liu
- School of Nursing and Public Health, Yangzhou University, Yangzhou, Jiangsu Province, China.
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