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Eskola L, Silverman E, Rogers S, Zelenski A. Right-sizing interprofessional team training for serious-illness communication: A strength-based approach. PEC INNOVATION 2024; 4:100267. [PMID: 38414869 PMCID: PMC10897908 DOI: 10.1016/j.pecinn.2024.100267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/12/2024] [Accepted: 02/15/2024] [Indexed: 02/29/2024]
Abstract
Objective Palliative care communication skills help tailor care to patients' goals. With a palliative care physician shortage, non-physicians must gain these serious illness communication skills. Historically, trainings have targeted physician-only groups; our goal was to train interprofessional teams. Methods Workshops were conducted to teach palliative care communication skills and interprofessional communication. Participants completed surveys which included questions from the Interpersonal Reactivity Index, the Ekman Faces tool, the Consultation and Relational Empathy measure, open-ended questions about empathy, and measures of effective interprofessional practice. Results Participants felt the workshop improved their ability to listen (p < 0.001), understand patients' concerns (p < 0.001), and show compassion (p = 0.008). It increased the perceived value of peer observation (p < 0.001) and ability to reflect (p = 0.02) during complex conversations. Different types of professionals adopted different communication goals, though all affirmed the importance of active listening. Participants felt they improved their ability to work within an interprofessional team. Conclusions The course effectively trained 71 clinicians, the majority non-physicians, in serious illness communication and interprofessional team communication skills, and could be reproduced in similar settings. Innovation We adapted an approach common to physician-only trainings to diverse interprofessional groups, added a team-based component using Applied Improvisation, and demonstrated its effectiveness.
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Affiliation(s)
- Liana Eskola
- Department of Medicine, Department of Veterans Affairs, William S. Middleton Memorial Hospital and Clinics, 2500 Overlook Terrace, Madison, WI 53705, USA
- Department of Medicine, Division of Hematology, Medical Oncology, and Palliative Care, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave., Madison, WI 53792, USA
| | - Ethan Silverman
- Department of Medicine, Division of Hematology, Medical Oncology, and Palliative Care, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave., Madison, WI 53792, USA
- Department of Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, 200 Lothrop St., Suite 933W, Pittsburgh, PA 15213, USA
| | - Sarah Rogers
- Department of Social Work, Department of Veterans Affairs, William S. Middleton Memorial Hospital and Clinics, 2500 Overlook Terrace, Madison, WI 53705, United States of America
- Department of Mental Health, Department of Veterans Affairs, William S. Middleton Memorial Hospital and Clinics, 2500 Overlook Terrace, Madison, WI 53705, United States of America
| | - Amy Zelenski
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave., Madison, WI 53792, USA
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Chan CA, Windish DM, Spak JM, Makansi N. State-of-the-art review of medical improvisation curricula to teach health professional learners communication. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:1025-1046. [PMID: 37921903 DOI: 10.1007/s10459-023-10296-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 10/08/2023] [Indexed: 11/05/2023]
Abstract
Medical improvisation (improv) applies theater principles and techniques to improve communication and teamwork with health professionals (HP). Improv curricula have increased over time, but little is known about best practices in curricula development, implementation, and assessment. We sought to complete a state-of-the-art review of medical improv curricula to teach HP learners communication skills. A literature search of MEDLINE and 8 other databases on HP medical education and medical improv communication curricula occurred. We screened 1869 articles published from 2012 to 2022. Seventeen articles were selected for extraction and synthesis. Common curricular goals included improving interprofessional, interpersonal, and empathetic communication. Curricula often lacked alignment between learning objectives and improv exercises. Sessions occurred once (65%) or were longitudinal (35%). Only 24% reported a full description of their intervention. Few reported details on the content of curricula. Evaluations often focused on feasibility and acceptability. Heterogeneity exists in the development, implementation, and assessment of improv curricula. Low-quality evidence was provided to support the use of medical improv to teach communication skills to HP learners. Improv curricula were feasible, and acceptable to learners. We offer recommendations to guide future medical improv curricula development.
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Affiliation(s)
- Carolyn A Chan
- Division of General Internal Medicine, Department of Internal Medicine, University of Cincinnati Medical Center, 3131 Harvey Ave, Suite 104, Cincinnati, OH, 45224, USA.
| | - Donna M Windish
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Judy M Spak
- Academic Research and Education, Cushing/Whitney Medical Library, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Nora Makansi
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, H3A1G1, Canada
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Davis K, Kessler D, Lemke D, Doughty C. Applied Improvisation: Putting Behavioral Skills Center Stage in Simulation-Based Team Training. Simul Healthc 2024:01266021-990000000-00108. [PMID: 38421367 DOI: 10.1097/sih.0000000000000785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
SUMMARY STATEMENT Behavioral skills, sometimes referred to as nontechnical skills or team-based skills, are fundamental to simulation-based team training. These skills should be afforded the same deliberate practice and development as clinical knowledge and procedural skills in health care education. Applied improvisation, the use of theater games designed to improve individual and team performance, is gaining traction in health care education to train behavioral skills. Simulation educators are experts in experiential learning with debriefing and therefore well poised to incorporate applied improvisational exercises into team training activities.
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Affiliation(s)
- Kasey Davis
- From the Division of Critical Care Medicine (K.D.), Department of Pediatrics, Baylor College of Medicine, Houston, TX; Division of Emergency Medicine (D.K.), Columbia University College of Physicians and Surgeons, New York, NY; Division of Emergency Medicine (D.L., C.D.), Department of Pediatrics, Baylor College of Medicine, Houston, TX; and Simulation Center (K.D., D.L., C.D.), Texas Children's Hospital, Houston, TX
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Chan CA, Chou E, LaDisa AG, Mehta A, Zelenski A, Longtin K. Using nominal group technique to determine skills that applied improvisation can teach health profession education learners. PEC INNOVATION 2023; 3:100194. [PMID: 37576803 PMCID: PMC10415759 DOI: 10.1016/j.pecinn.2023.100194] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/15/2023]
Abstract
Objective Applied improvisation (AI) is an approach used in health professions (HP) education to teach skills essential for clinical practice such as communication, teamwork, and empathy. Little is known about which skills can be developed using AI, or those which an AI should prioritize. Our research aims to identify skills essential to include in an AI curriculum for HP learners. Methods A modified nominal group technique (NGT) was conducted to identify and prioritize specific skills which can be taught using AI. This involved silent generation of ideas, round robin, discussions, 2-rounds of preliminary voting, and a final ranking survey to determine a prioritized list of skills to include in an AI curriculum for HP learners. Results Six content experts participated in the NGT meeting. Initially, 83 skills were identified, and through NGT, a final list of 11 skills essential to an AI curriculum were determined including: adaptability, affirmation of others, acceptance, active listening, being present, cooperation, collaboration with other, advancement, compassionate communication, sharpened non-verbal communication, resilience. Conclusion Essential skills for an AI curriculum relate to adaptability, attunement, collaboration, affirmation, and advancement. Innovation This study is a novel application of NGT as a strategy to organize an approach to curriculum innovations.
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Affiliation(s)
- Carolyn A. Chan
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, USA
| | - Erica Chou
- Section of Pediatric Hospital Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, USA
| | - Anne Graff LaDisa
- Department of Pharmacy Practice, Concordia University Wisconsin School of Pharmacy, Mequon, USA
| | - Ankit Mehta
- Department of Internal Medicine, University of Minnesota, Minneapolis, USA
| | - Amy Zelenski
- Division of General Internal Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Krista Longtin
- Department of Communication Studies, IUPUI, USA
- Indiana University School of Medicine, Indianapolis, USA
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Chan CA, Cabaniss P, Morford KL, Martino S, Martin A, Windish DM. Medical improvisation-based motivational interviewing for internal medicine residents: Mixed-methods evaluation of a novel course. MEDICAL TEACHER 2023; 45:1411-1418. [PMID: 37378496 DOI: 10.1080/0142159x.2023.2225725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
PURPOSE Develop and assess a novel medical improvisation-based motivational interviewing (MI) curriculum for residents. MATERIALS AND METHODS A 6-h medical improv-based MI curriculum occurred in 2022 for internal medicine residents. A mixed-methods evaluation included: pre- and post-role plays using the Motivational Interviewing Treatment Integrity Score (MITI) to assess MI competency, a post-course survey assessing confidence, and focus groups to understand learning through improvisation. RESULTS Participants increased their confidence in applying MI skills after the curriculum in responding to a patient's argument against change (29% pre vs. 72% post, p < 0.001), eliciting change talk (21% vs. 86%, p < 0.001), and providing information in an MI-centric way (39% vs. 86%, p < 0.001). All role-play participants achieved at least beginning proficiency on MITI technical and relational global summary scores post-course. MI-adherent behaviors increased, and MI-non-adherent behaviors decreased in post-course role plays. Themes on learning through improvisation included: (1) improvisation can enhance the learning of MI skills, (2) using non-medical scenarios in improvisation exercises has benefits, and (3) trying improvisation had positive effects on the learning environment. DISCUSSION A medical improvisation-based course is a promising, engaging way to teach residents MI skills and can improve competence and confidence with MI.
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Affiliation(s)
- Carolyn A Chan
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | | | - Kenneth L Morford
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Steve Martino
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Andrés Martin
- Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Donna M Windish
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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Westcott S, Simms K, van Kampen K, Jafine H, Chan TM. Off-Script, Online: Virtual Medical Improv Pilot Program for Enhancing Well-being and Clinical Skills among Psychiatry Residents. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2023; 47:374-379. [PMID: 37101105 PMCID: PMC10132442 DOI: 10.1007/s40596-023-01778-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 03/24/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE Clinical interactions demand a balance of structure and flexibility in response to unpredictable situations. Medical improv is a form of experiential learning that applies techniques from improvisational theater to the healthcare setting, deliberately targeting clinical skills of communication, teamwork, and cognitive abilities. Psychiatry Education through Play and Talk (PEP Talks) is a novel medical improv program designed specifically for psychiatry residents with the goal of improving communication, teamwork, and conflict resolution skills, as well as enhancing residents' well-being and capacity for self-reflection. METHODS PEP Talks was delivered virtually by an experienced medical improv facilitator in spring 2021 to a self-selected group of psychiatry residents at a Canadian university. Aligned with the context-input-process-product (CIPP) evaluation model, outcomes were assessed through mixed methods surveys, recorded debriefings, and a focus group. RESULTS PEP Talks enhanced residents' self-reported well-being, reflective capacity, and communication skills. Participants made qualitative connections between PEP Talks and their well-being, inter- and intra-personal skills, and clinical experiences in psychiatry. Processes in PEP Talks that led to these outcomes included the following: joy, building community, personal reflection and discovery, going off-script, immersion, and virtual engagement. CONCLUSIONS Virtual medical improv offers an innovative solution to the pedagogical challenges of training psychiatrists to be proficient communicators, collaborators, and professionals capable of reflective practice. Additionally, this innovation demonstrates that medical improv can be delivered in a virtual format and may offer a unique solution to support resident well-being and foster connection amid remote learning during a global pandemic.
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Landry-Wegener BA, Kaniecki T, Gips J, Lebo R, Levine RB. Drama Training as a Tool to Teach Medical Trainees Communication Skills: A Scoping Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:851-860. [PMID: 36538658 DOI: 10.1097/acm.0000000000005121] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE Recognizing the similarities between the skills an actor needs and those required of a physician in clinical communication, medical educators have begun to create drama-based interventions to teach communication skills. The purpose of this scoping review was to summarize existing educational interventions that use drama training to teach medical trainees communication skills. METHOD The authors searched PubMed, CINAHL Plus, Embase, ERIC, and Web of Science Core Collection multiple times beginning in March 2020 through March 2022. Articles were included if they (1) described components of an educational intervention, (2) used an active intervention based on drama training, (3) stated a curricular goal of improving learners' communication skills, and (4) included medical trainee learners. Data extracted included the details of the targeted learners and educational interventions, assessment tools, and outcomes. The quality of each study was assessed. RESULTS Thirty articles met the inclusion criteria. Twenty-five (83%) articles included acting and improvisation exercises, 9 (30%) used some or all of the conventions of forum theater, and 3 (10%) used dramatic performance. The interventions included undergraduate, graduate, and continuing medical education learners. Most were elective and involved a member of the theatrical community. Although low overall study quality (average MERSQI score was 8.5) limited the strength of the evidence, of the 8 articles that evaluated learners' knowledge, skills, and/or behaviors, the majority showed an initial improvement in communication skills post-intervention. CONCLUSIONS This review is the first, to the authors' knowledge, to focus on the curricular goal of improving communication skills and to include a broader scope (beyond medical improv) of drama trainings. While the included articles represent a diverse group of interventions, generally they reported an outcome of improved communication skills in their learners. More high-quality studies are needed to determine best practices and the generalizability of drama-based initiatives.
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Affiliation(s)
- Bernard A Landry-Wegener
- B.A. Landry-Wegener is assistant professor, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Timothy Kaniecki
- T. Kaniecki is a rheumatology fellow, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Julia Gips
- J. Gips is a resident physician, Osler Medical Residency, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rachael Lebo
- R. Lebo is clinical services librarian, Wegner Health Sciences Library, University of South Dakota, Sioux Falls, South Dakota
| | - Rachel B Levine
- R.B. Levine is professor and associate dean for faculty educational development, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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8
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Li W, Scherr CL, Fenter RB, Watson KL, Wicklund CA. Exploring a brief medical improvisational performing arts intervention for genetic counseling graduate students. J Genet Couns 2022; 31:1193-1205. [PMID: 35617028 PMCID: PMC9795887 DOI: 10.1002/jgc4.1590] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/27/2022] [Accepted: 04/30/2022] [Indexed: 12/30/2022]
Abstract
Psychosocial counseling is the foundation of genetic counseling. Genetic counseling students are required to receive in-depth training on psychosocial counseling techniques. In other medical disciplines, "medical improv," an educational method derived from improvisational theatre, has been used to allow trainees to practice clinical skills without also having to focus on medical knowledge they've not yet mastered. The present study aims to investigate the acceptability of medical improv as an educational tool for genetic counseling students. Fourteen genetic counseling students and new genetic counselors completed a 2-hr medical improv workshop and participated in follow-up interviews to discuss the workshop. Participants' responses to the intervention were positive, with 92.9% of participants responding that they would recommend medical improv training to other genetic counseling students. Participants described the medical improv workshop as helping build psychosocial skills in a safe environment, which may facilitate the use of more advanced counseling skills in clinical situations. By training students to practice psychosocial skills and building students' confidence, medical improv may help genetic counseling students and genetic counselors be more effective in challenging clinical situations, and to feel more comfortable in experimenting with new ideas and psychosocial techniques in their clinical practice.
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Affiliation(s)
- Weilong Li
- Graduate Program in Genetic CounselingNorthwestern UniversityChicagoIllinoisUSA
- Physician Assistant Studies ProgramSalus UniversityElkins ParkPennsylvaniaUSA
| | - Courtney L. Scherr
- Department of Communication StudiesNorthwestern UniversityChicagoIllinoisUSA
| | | | - Katie L. Watson
- Departments of Medical Social SciencesMedical Education and Obstetrics & GynecologyFeinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
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Cerceo E, Zimmerman M, DeLisser HM. Diversity, Equity, and Inclusion: Moving from Performance to Transformation Through the Arts and Humanities. J Gen Intern Med 2022; 37:944-946. [PMID: 34993859 PMCID: PMC8904695 DOI: 10.1007/s11606-021-07225-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 10/19/2021] [Indexed: 11/26/2022]
Abstract
Effective engagement on issues of diversity, equity, and inclusion (DEI) requires activities that promote deep introspection and group conversations that serve to complement and build upon formal DEI presentations. The arts and humanities by their nature allow for intentional and sustained reflection and have the potential to be transformative of thinking. We therefore propose that the next phase of institutional pro-equity/anti-racism efforts includes arts- and humanities-based initiatives to facilitate reflection and that serve to complement and build upon formal DEI didactic presentations, implicit bias workshops, and anti-racism training.
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Affiliation(s)
- Elizabeth Cerceo
- Department of Hospital Medicine, Cooper Medical School of Rowan University, Cooper University Healthcare, Camden, NJ, USA.
| | | | - Horace M DeLisser
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Neel N, Maury JM, Lander L. Improvising through a pandemic: adapting a medical improv elective over Zoom. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2021; 12:243-244. [PMID: 34842176 PMCID: PMC8995010 DOI: 10.5116/ijme.6183.b4ef] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 11/04/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Nicholas Neel
- University of California, San Diego School of Medicine, San Diego, CA, USA
| | - John-Michael Maury
- Professional Development Center, Division of Medical Education, School of Medicine, University of California San Diego, CA, USA
| | - Lina Lander
- Department of Family Medicine, University of California, San Diego, CA, USA
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Zhou YC, Tan SR, Tan CGH, Ng MSP, Lim KH, Tan LHE, Ong YT, Cheong CWS, Chin AMC, Chiam M, Chia EWY, Lim C, Wijaya L, Chowdhury AR, Kwek JW, Fong W, Somasundaram N, Ong EK, Mason S, Krishna LKR. A systematic scoping review of approaches to teaching and assessing empathy in medicine. BMC MEDICAL EDUCATION 2021; 21:292. [PMID: 34020647 PMCID: PMC8140468 DOI: 10.1186/s12909-021-02697-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 04/21/2021] [Indexed: 05/03/2023]
Abstract
BACKGROUND Empathy is pivotal to effective clinical care. Yet, the art of nurturing and assessing empathy in medical schools is rarely consistent and poorly studied. To inform future design of programs aimed at nurturing empathy in medical students and doctors, a review is proposed. METHODS This systematic scoping review (SSR) employs a novel approach called the Systematic Evidence Based Approach (SEBA) to enhance the reproducibility and transparency of the process. This 6-stage SSR in SEBA involved three teams of independent researchers who reviewed eight bibliographic and grey literature databases and performed concurrent thematic and content analysis to evaluate the data. RESULTS In total, 24429 abstracts were identified, 1188 reviewed, and 136 included for analysis. Thematic and content analysis revealed five similar themes/categories. These comprised the 1) definition of empathy, 2) approaches to nurturing empathy, 3) methods to assessing empathy, 4) outcome measures, and 5) enablers/barriers to a successful curriculum. CONCLUSIONS Nurturing empathy in medicine occurs in stages, thus underlining the need for it to be integrated into a formal program built around a spiralled curriculum. We forward a framework built upon these stages and focus attention on effective assessments at each stage of the program. Tellingly, there is also a clear need to consider the link between nurturing empathy and one's professional identity formation. This foregrounds the need for more effective tools to assess empathy and to better understand their role in longitudinal and portfolio based learning programs.
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Affiliation(s)
- Yi Cheng Zhou
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Shien Ru Tan
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Chester Guan Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Matthew Song Peng Ng
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Kia Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Lorraine Hui En Tan
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Yun Ting Ong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Clarissa Wei Shuen Cheong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Annelissa Mien Chew Chin
- Medical Library, National University of Singapore Libraries, National University of Singapore Blk MD6, Centre for Translational Medicine, 14 Medical Dr, #05-01, Singapore, 117599, Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Elisha Wan Ying Chia
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Crystal Lim
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
- Medical Social Services, Singapore General Hospital, 16 College Road, Block 3 Level 1, Singapore, 169854, Singapore
| | - Limin Wijaya
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
- Department of Infectious Diseases, Singapore General Hospital, 16 College Road, Block 6 Level 7, Singapore, 169854, Singapore
| | - Anupama Roy Chowdhury
- Department of General Medicine, Sengkang General Hospital, 110 Sengkang East Way, Singapore, 544886, Singapore
| | - Jin Wei Kwek
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
- Division of Oncologic Imaging, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Warren Fong
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, 16 College Road, Block 6 Level 9, Singapore, 169854, Singapore
| | - Nagavalli Somasundaram
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Eng Koon Ong
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
| | - Stephen Mason
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, Cancer Research Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore.
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore.
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore.
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, Cancer Research Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK.
- Centre of Biomedical Ethics, National University of Singapore, Blk MD 11, 10 Medical Drive, #02-03, Singapore, 117597, Singapore.
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC c/o Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436, Singapore.
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