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Doherty M, Abdullah QK. Using Project ECHO to deliver a tele-mentoring and teaching program on palliative care in South Asia: Interpretive description of participants' experiences with a community of practice for learning. Palliat Support Care 2024:1-9. [PMID: 38736371 DOI: 10.1017/s1478951524000762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
OBJECTIVES To explore the learning experiences of participants (learners and teachers), in a yearlong tele-teaching and mentoring program on pediatric palliative care, which was conducted using the Project ECHO (Extension for Community Healthcare Outcomes) model and consisted of 27 teaching and clinical case discussion sessions for palliative medicine residents in India and Bangladesh. The goal of the study is to explore how participation and learning is motivated and sustained for both residents and teachers, including the motivators and challenges to participation and learning in a novel online format. METHODS Qualitative interviews with ECHO participants, including learners and teachers were conducted. Interviews were recorded and transcribed. Thematic analysis of interview data was conducted within an interpretive description approach. RESULTS Eleven physicians (6 residents, 5 teachers) participated in interviews. Key elements of the ECHO program which participants identified as supporting learning and participation include small group discussions, a flipped classroom, and asynchronous interactions through social media. Individual learner characteristics including effective self-reflection and personal circumstances impact learning. Providing opportunities for a diverse group of learners and teachers, to interact in communities of practice (COP) enhances learning. Three major themes and 6 subthemes describing learning processes were identified. Themes included (1) ECHO program structure, (2) learner characteristics, and (3) COP. Subthemes included flipped classroom, breakout rooms, learning resources, personal circumstances, self-awareness of learning needs, and community interactions. SIGNIFICANCE OF RESULTS Project ECHO suggests a novel model to train health providers, which is effective in low- and middle-income countries. Online learning programs can lead to learning through community of practice when learners and teachers are able to interact and engage in peer support and reflective practice. Educators should consider incorporating small group discussions, a flipped classroom design, and opportunities for asynchronous interactions to enhance learning for participants in online learning programs.
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Affiliation(s)
- Megan Doherty
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
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PENS approach for breaking bad news in the oncology outpatient setting: a real-world report. Support Care Cancer 2023; 31:13. [PMID: 36513796 PMCID: PMC9747823 DOI: 10.1007/s00520-022-07458-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/25/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Breaking bad news (BBN) is a vital part of oncology practice. We conducted this study to assess an abbreviated PENS protocol [Patient preference, Explanation, Next appointment, and Support] for BBN in oncology outpatient (OP) settings. METHODS This observational study was conducted in a university teaching hospital, including cancer patients who were unaware of their condition and willing to discuss their disease status. The duration of BBN was the primary outcome. After the BBN session, patients filled a validated questionnaire; response scores of ≤ 13 were classified as content with BBN. RESULTS Fifty patients (mean age 53.7 years, range 28-76) were included in the study. The average duration of BBN was 6.1 (range 2-11) min. Assessed by the response score sum, 43 (86%) patients were satisfied with BBN. Only three (6%) of the discontented patients felt that the BBN duration was too short. Most (94%) of patients reported that they understood the information imparted during the BBN session. After the session, 36 (72%) patients admitted to either feeling the same or reassured compared to before the session. The oncologists also were comfortable with PENS. CONCLUSIONS The PENS approach is a practical method for BBN, especially when the oncologists have higher OP workloads. More extensive trials are required to validate the protocol in other settings. TRIAL REGISTRATION Clinical Trial Registry of India (CTRI/2021/07/034707).
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Salins N, Hughes S, Preston N. Presuppositions, cost–benefit, collaboration, and competency impacts palliative care referral in paediatric oncology: a qualitative study. Palliat Care 2022; 21:215. [DOI: 10.1186/s12904-022-01105-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022] Open
Abstract
Abstract
Background
Although a significant proportion of children with cancer need palliative care, few are referred or referred late, with oncologists and haematologists gatekeeping the referral process. We aimed to explore the facilitators and barriers to palliative care referral.
Methods
Twenty-two paediatric oncologists and haematologists were purposively recruited and interviewed. Data were analysed using reflexive thematic analysis. Findings were interpreted using the critical realist paradigm.
Results
Four themes were generated. 1) Oncologists expressed concern about the competency of palliative care teams. Palliative care often symbolised therapeutic failure and abandonment, which hindered referral. Trustworthy palliative care providers had clinical competence, benevolence, and knowledge of oncology and paediatrics. 2) Making a palliative care referral was associated with stigma, navigating illness-related factors, negative family attitudes and limited resources, impeding palliative care referral. 3) There were benefits to palliative care referral, including symptom management and psychosocial support for patients. However, some could see interactions with the palliative care team as interference hindering future referrals. 4) Suggested strategies for developing an integrated palliative care model include evident collaboration between oncology and palliative care, early referral, rebranding palliative care as symptom control and an accessible, knowledgeable, and proactive palliative care team.
Conclusion
Presuppositions about palliative care, the task of making a referral, and its cost-benefits influenced referral behaviour. Early association with an efficient rebranded palliative care team might enhance integration.
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Knowledge and perceptions in palliative care among undergraduate medical students in Puducherry, South India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Chandra A, Bhatnagar S, Kumar R, Rai SK, Nongkynrih B. Estimating the Need for Palliative Care in an Urban Resettlement Colony of New Delhi, North India. Indian J Palliat Care 2022; 28:434-438. [DOI: 10.25259/ijpc_60_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/05/2022] [Indexed: 11/04/2022] Open
Abstract
Objectives:
This study was aimed to estimate the need for palliative care in an urban resettlement colony of Dakshinpuri Extension, New Delhi.
Material and Methods:
This was a community-based cross-sectional study conducted in New Delhi. We trained four multipurpose workers to screen the households during their routine household-to-household visits. The screening for the need for palliative care was done using three questions – that is, (1) presence of a bedridden patient or (2) person in need for help in activities of daily living or (3) not able to go for work due to any physical chronic illness. If the answer to any of the three screening questions was yes for any member in a household, then these households were visited by a community physician trained in palliative care and a medical social service officer to confirm the need for palliative care. Patients were administered a semi-structured questionnaire containing the sociodemographic details and an assessment of disease status and review of health records was done. The patient and his/her caregiver were also assessed for awareness regarding palliative care.
Results:
A total of 2028 households were screened and the need for palliative care was found to be 1.5/1000 population (95% CI: 0.9–2.1). The mean age (SD) of patients who need palliative care was 60 years (SD–12.9). The common diseases which required palliative care were stroke with a focal neurological deficit (45.8%), osteoarthritis with marked dependence (20.8%) and cancer (12.5%). None of the patients was receiving palliative care as patients and their caregivers were not aware of the term palliative care/end of life care/home care for bedridden people/community-based care.
Conclusion:
The need for palliative care in an urban resettlement colony of North India was found to be 1.1/1000 population. Further studies are required to estimate the need for palliative care in North India.
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Affiliation(s)
- Ankit Chandra
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India,
| | - Sushma Bhatnagar
- Department of Onco-Anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India,
| | - Rakesh Kumar
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India,
| | - Sanjay Kumar Rai
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India,
| | - Baridalyne Nongkynrih
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India,
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Pai RS, Monteiro G, Tarey SD. Attitudes, Aptitudes, Barriers and Knowledge of Pain Physicians towards Palliative Care Practice - A National Survey, India. Indian J Palliat Care 2021; 27:242-250. [PMID: 34511791 PMCID: PMC8428885 DOI: 10.25259/ijpc_325_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 06/19/2021] [Indexed: 11/25/2022] Open
Abstract
Objectives: The bio-psycho-socio-spiritual model is a common management approach in palliative care (PC) and chronic pain medicine (CPM), adopted by PC Physicians and Pain Physicians (PPs), respectively. There is a dearth of services and personnel of PC in India. As PPs are familiar with pain management and the bio-psycho-socio-spiritual model, we hypothesised that they would be willing to incorporate PC in their practice and therefore, sought to understand their attitudes/aptitudes/barriers/knowledge towards it. Materials and Methods: We did a cross-sectional cohort study through a national survey of Indian PPs. The ten- item validated, survey questionnaire was mailed to 1300 PPs having E mail and registered with Indian Society for Study of Pain. Results: We received responses from 6.6% of the PPs. About 10.39% did not want to practice PC; the rest were either practicing or wanted to, or were unable to. 81.8% had <10 years CPM experience while the rest had 10–15 years. About 53.3% PPs had <10 years’ experience in PC; 10.4% had > 10 years and the rest had not practiced. About 70% were motivated by human suffering or had “personal reasons.” About 40.26% had no barriers; the rest cited stress or lack of infrastructure/knowledge/skills/time/financial compensation. The majority chose institutional courses for training and the popular choice of duration of the course was 3 months. The opinion on financial viability/non-viability of PC was equally divided among the respondents. About 62.3% had “knowledge” but half of them lacked “skills;” 27.6% lacked both; the rest had no inclination towards PC. About a third felt multi-disciplinary care was feasible while half felt that it was partially feasible. Conclusion: Policy-makers, at regional to global levels are strategizing options for popularizing PC since it supports the dualistic model of cure and care, most essential for both, chronic-debilitating or life-limiting illnesses. The poor response to our survey was a major limiting factor. However, among the respondents, the majority showed both aptitude and a favourable attitude for PC practice. The inability to identify major barriers for not choosing PC did not support our hypothesis. However, we feel that PPs are a cohort who can be motivated/ encouraged to take up some form of brief, comprehensive courses in PC so that they can be conversant with the specific knowledge and skills needed to practice the multi-dimensional aspects of PC in their own settings.
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Affiliation(s)
- Renuka Shantharam Pai
- Department of Pain and Palliative Medicine, St John's National Academy of Health Sciences, Bengaluru, Karnataka, India
| | - Geraldine Monteiro
- Department of Pain and Palliative Medicine, St John's National Academy of Health Sciences, Bengaluru, Karnataka, India
| | - Subash D Tarey
- Department of Pain and Palliative Medicine, St John's National Academy of Health Sciences, Bengaluru, Karnataka, India
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Istl AC, Gage MM, Esquivel J, Ahuja N, Greer JB, Johnston FM. Management of Low-Grade Appendiceal Mucinous Neoplasms (LAMN): An International Survey of Surgeons Performing CRS and HIPEC. Ann Surg Oncol 2021; 28:3831-3837. [PMID: 33393023 DOI: 10.1245/s10434-020-09312-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 10/13/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Low-grade appendiceal mucinous neoplasms (LAMN) are commonly managed by community surgeons at diagnosis. There is variability in the treatment of LAMN, both by community and specialist providers. We assessed current management practices for LAMN across surgeons with expertise in peritoneal surface malignancies (PSM). METHODS An online survey was sent to 106 international surgeons specializing in PSM. The survey assessed demographics, favored pre-referral management, and definitive management practices for LAMN. RESULTS The response rate was 40% (67% USA, 33% international). Respondents had performed a median of 18 (interquartile range [IQR] 7.75-29) HIPEC cases in the last year, of which 10 (IQR 4-20) were for LAMN. Ninety-three percent reported more than half of LAMN referrals had already undergone surgery-an estimated 50% appendectomy and 20% right hemicolectomy (RH). No surgeon respondents supported performing right hemicolectomy before referral. For LAMN confined to the appendix, 86% of respondents would definitively treat with appendectomy. In the presence of mucinous implants, 24% would observe after appendectomy and 76% would proceed with HIPEC. All would perform HIPEC if implants contained tumor cells. When LAMN involved the appendiceal base, 67% of respondents would proceed with partial cecectomy, while 33% favored RH. CONCLUSIONS Pre-referral management of LAMN is not standardized and 20% of patients were referred to a surgeon who performs CRS/HIPEC after a right hemicolectomy that would not have been recommended. Management of LAMN by surgeons who treat PSM is also variable. Long-term data and identification of prognostic features are necessary to generate consensus on the optimal management of these complex patients.
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Affiliation(s)
| | - Michele M Gage
- Department of Surgery, Johns Hopkins University, Baltimore, MD, 21287, USA
| | | | - Nita Ahuja
- Department of Surgery, Yale University, New Haven, CT, USA
| | - Jonathan B Greer
- Department of Surgery, Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Fabian M Johnston
- Department of Surgery, Johns Hopkins University, Baltimore, MD, 21287, USA.
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Mailankody S, Rao SR. "PENS" approach for breaking bad news-a short and sweet way! Support Care Cancer 2020; 29:1157-1159. [PMID: 33025228 DOI: 10.1007/s00520-020-05807-0] [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: 08/12/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
India has a distinct pattern of cancer care delivery, with unique sociocultural milieu and patient characteristics. In the current era of patient-centered and personalized care, there is an unmet need for an abbreviated protocol for breaking bad news to cancer patients suitable for the Indian outpatient setting. We propose a short four-step protocol for breaking bad news effectively and caringly, in the outpatient department of oncology clinics.
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Affiliation(s)
- Sharada Mailankody
- Department of Medical Oncology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India. .,Department of Medical Oncology, Manipal Comprehensive Cancer Care Centre, Shirdi Sai Baba Cancer Block, Kasturba Medical College, Madhavnagar, Eshwarnagar, Manipal, 576104, Karnataka, India.
| | - Seema Rajesh Rao
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.,Lien Collaborative for Palliative Care, Asia Pacific Hospice Palliative Network, Singapore, Singapore.,School of Medicine, Cardiff, UK
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Nair M, Kumar P, Mahajan R, Harshana A, Kurup KK, Moreto-Planas L, Burza S. Knowledge, Attitudes, and Practices Regarding Palliative Care: A Mixed-Methods Study from Bihar, India. J Palliat Care 2020; 36:9-11. [PMID: 32727299 DOI: 10.1177/0825859720946514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Mohit Nair
- 16309Medecins Sans Frontieres, New Delhi, India
| | - Pragya Kumar
- All India Institute of Medical Sciences, Patna, India
| | | | | | | | | | - Sakib Burza
- 16309Medecins Sans Frontieres, New Delhi, India
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