Second-year Italian medical students' attitudes toward care of the dying patient: an exploratory study

Preclinical and Clinical Medical Student Attitudes Toward the Care of the Dying: Testing the 9-Item Version of the Frommelt Attitude Toward the Care of the Dying Scale

The demand for palliative care is increasing worldwide. Beyond the acquisition of technical knowledge, the development of adequate personal disposition toward the relationship with the dying is a key aspect of the future training of doctors. This study evaluates the psychometric properties of the 9-Item Version of the Frommelt Attitude Toward the Care of the Dying Scale (FATCOD-9IT) the authors recently developed and its capability to distinguish medical students with different attitudes toward the care of the dying and at different stages of medical training. The study included 595 medical students, 400 at the first and 195 at the fifth year. The Rasch rating scale model was specified to assess scale dimensionality, functioning and measurement invariance. Internal consistency, test-retest reliability and between-group difference sensitivity (first-vs fifth-year students) were evaluated using Cronbach's alpha, Intraclass correlation coefficients, Paired sample t-test and Mann-Whitney U. Scale unidimensionality, rating scale functioning and measurement invariance were established. The scale demonstrated good internal consistency and test-retest reliability, and adequately discriminated between first- and fifth-year students. The study supports the validity and reliability of the FATCOD-9IT. Its effectiveness, simplicity of compilation and score calculation, and gratuitousness encourage its widespread use as fast assessment of the medical student attitudes toward the care of the dying.

Nursing Students' Understanding of Palliative Care in Palestine

Palliative care is a method of preventing and alleviating suffering for patients who have been diagnosed with terminal diseases by early detection, accurate assessments, and pain and symptom management. Patients and their families can then mitigate related physical, psychological, and spiritual challenges and thus will have a better quality of life. This article reports a study that evaluated undergraduate nursing students' knowledge of and attitude and self-efficacy toward palliative and end-of-life care in Palestine. A descriptive, cross-sectional design was used among a convenience sample of 449 undergraduate nursing students at the end of their second, third, and fourth years. The results of this research revealed that nursing students had low levels of knowledge about palliative care and low self-efficacy toward end-of-life care. The majority of students reported a positive disposition toward the provision of end-of-life care. The most important predictors of knowledge, attitudes, and self-efficacy were age, having attended a seminar/lecture on the issue, experiencing death while providing care, and having experienced a death in the family or close friends. Furthermore, elevated levels of knowledge were significantly associated with higher level of attitude (P < .001) about palliative care.

The Relationship between Cognitively-Based Clinical Empathy and Attitudes toward Death and Dying in Medical Students

Empathy has a potentially complicated relationship with dealing with death and dying. Having clinical empathy can improve interactions with dying, but educational interventions aimed at fostering empathy may cause medical students to connect emotionally with dying patients and behave unprofessionally out of self-defense. Cognitively-based clinical empathy should lead to positive attitudes toward death and dying by adhering to the principles of detached concern and professionalism. Hypotheses: The main components of cognitively-based clinical empathy are negatively correlated with (1) difficulty communicating with dying patients and their relatives, and (2) avoidance of death and dying. Method: This cross-sectional study included 372 medical students from two universities in Konya, Turkey. Data were collected via a survey consisting of three parts: socio-demographic information, the Turkish version of Jefferson Scale of Empathy-Student Version (JSE-S), and the Turkish Approach to Death and Dying Patients Attitude Scale. Independent samples t-test and one-way analysis of variance were used for comparative analysis. Bivariate and partial correlation analyses were used to assess the associations between variables. Results: Perspective-taking and compassionate care were significantly and moderately positively correlated with difficulty communicating with the dying and their relatives. Perspective-taking and compassionate care had significant, but weak positive correlations with avoiding death and dying. There was no significant correlation between standing in the patient's shoes and either communication or avoidance. Conclusions: Both hypotheses were rejected. The present findings raise questions regarding whether the JSE-S is an effective operationalization of cognitively-based clinical empathy. Perspective-taking and compassionate care as measured by the JSE-S may reflect a propensity to engaging emotionally that leads to negative attitudes toward death and dying in medical students. If so, reducing the negative effects of emotional engagement seems crucial for developing positive attitudes toward death and dying in medical students.

A Questionnaire Study on the Attitude towards Death of the Nursing Interns in Eight Teaching Hospitals in Jiangsu, China

Introduction

Nurses play an important role in caring for dying patients. However, little is known about the attitude towards death of the registered nurses in China.

Materials and Methods

A knowledge, attitude, and the practice (KAP) survey using standardized questionnaires was conducted at eight teaching hospitals in Jiangsu Province, China. In total, 366 nursing interns were recruited and 357 turned in valid response. Data about the interns' demographic characteristics and their attitudes to death in five domains, including fear of death, death avoidance, natural acceptance, approach acceptance, and escape acceptance, were collected.

Results

Compared to the norms, the nursing interns had statistically significantly higher scores in the domains death avoidance, approach acceptance, and fear of death (14.9 vs. 11.1, 26.2 vs. 24.2, and 20.3 vs. 19.0, respectively); however, statistically significantly lower scores were in the domains natural acceptance and escape acceptance (18.4 vs. 22.0, and 13.6 vs. 15.1, respectively). Religious belief, experience of a deceased relative in family, death education, and family atmosphere of discussing death are positively associated with one or more domains of attitude towards death.

Conclusion

The positive attitude towards death and death education before clinical practice are helpful for nursing interns when they care for dying patients. In general, the scores of attitude towards death are at a moderate level in the surveyed Chinese nursing interns. The death education for nursing students needs to be reinforced in China.

Medical Students Reflections Toward End-of-Life: a Hospice Experience

In this study, we want to investigate the personal reflections toward care of the dying cancer patients among second year medical students. Two hundred fifty second year medical students attended an elective short course on end-of-life care and a brief training at the hospice Valletta, in Turin. After group discussion, the students explained their reflections about their experience. Two different supervisors of the study analyzed themes of the students and subdivided them in categories according to the frequency. The most recurrent themes were symptoms, coping skills, distress, hospice, and insight. Each theme is subdivided in categories. In 95 of 250 transcriptions, students talked about symptom (38%), 60 transcriptions (24%) were focused on coping skills. In 45 transcriptions (18%) students described emotional distress, and in the other 30 (12%) transcriptions, they pinpointed hospice philosophy. Finally, 20 recorded data (8%) were characterized by insight theme. These results have emphasized the need to integrate the clinical training with an experiential training that prepares future doctors for dealing with suffering and death. The qualitative analysis of the reflections showed that the students gained a deep appreciation of the human identity of hospice patients and the relevance of a humanistic approach to care as future physicians.

Refining the Frommelt Attitude Toward the Care of the Dying Scale (FATCOD-B) for medical students: A confirmatory factor analysis and Rasch validation study

OBJECTIVE

Given the increasing number of patients requiring palliative care and the need for more professionals who are able to provide care for the dying comfortably, assessment of medical attitudes toward end-of-life care is becoming a key aspect of medical education. The present study aimed to establish whether the Frommelt Attitude Toward the Care Of the Dying, Form B (FATCOD-B) meets current psychometric standards of validity for an assessment tool in medical education.

METHOD

The participants were 200 undergraduate medical students. Since in a previous study the FATCOD-B was found to have a weak structure due to poor item validity, a refined version was proposed and tested in the present study. Confirmatory factor analysis and the Rasch model were employed to assess its dimensionality and psychometric properties.

RESULTS

The construct measured by the FATCOD-B continues to be misspecified. The tool has a two-dimensional structure. The first is well-structured and demonstrates appreciable measurement and discriminant capabilities. The second has low validity because its measurement capabilities are based on weakly correlated items.

SIGNIFICANCE OF RESULTS

Our results suggest that the FATCOD-B measures a two-dimensional construct and that only its first dimension is a robust measurement tool for use in medical education to evaluate undergraduates' attitudes about caring for the dying.

Development and Psychometric Testing Chinese Version of the Frommelt Attitude Toward Care of the Dying Scale, Form B in Nurses and Nursing Students

Nursing students' and nurses' attitudes toward caring for the dying need to be explored. The Frommelt Attitude Toward Care of the Dying (FATCOD) scale has not previously been used in the Chinese language. The aim of this study was to examine the reliability and validity of the Chinese version of the FATCOD scale. A convenience sample of 154 nurses and 200 nursing students was recruited. The Chinese version of the FATCOD was used to test construct validity, concurrent validity, convergent validity, and internal consistency. The Cronbach's alpha coefficient of the Chinese version of the FATCOD scale, Form B (FATCOD-B-C) was 0.790. The Cronbach's alpha coefficients for each subscale ranged from 0.610 to 0.863. The test-retest reliability was satisfactory (r = 0.959, P < 0.001). The overall content validity index was 0.92. Seven factors were identified in exploratory factor analysis. The results provide preliminary support for the reliability and validity of the FATCOD-B-C in nurses and nursing students. Additional psychometric testing is recommended to confirm the factor analysis, but this study provides further evidence of the applicability of the FATCOD-B-C in clinical care services.

Attitude of Palestinian Nursing Students Toward Caring for Dying Patients

Death is a natural process that occurs each day. Some nursing students may encounter the experience of taking care of a dying patient while others do not. Therefore, their attitude toward death and caring for dying patients may vary. The purpose of this study was to assess Palestinian student nurses’ attitudes toward death and caring for dying patients and their families. In a cross-sectional, descriptive study, all fourth-year students at the College of Nursing, Islamic University of Gaza, Palestine, were invited to participate in this study. A total of 141 students completed the Frommelt Attitude Toward Care of the Dying Scale Form B (FATCOD-B). Results revealed that the mean score on the FATCOD-B was (96.96 ± 8.30). Overall, nursing students in the sample demonstrated a relatively low attitude toward caring for dying patients and their families. No statistically significant differences of students’ attitudes toward caring for dying patients were found between male and female students nor between students who attended death cases and those who did not. The results suggest that theoretical nursing education should place more emphasis on palliative care to improve the quality of care at the end of life.

Confirmatory factor analysis of the Frommelt Attitude Toward Care of the Dying Scale (FATCOD-B) among Italian medical students

OBJECTIVE

A steady increase in the number of patients requiring end-of-life care has been observed during the last decades. The assessment of healthcare students' attitudes toward end-of-life care is an important step in their curriculum, as it provides information about their disposition to practice palliative medicine. The Frommelt Attitude Toward Care of the Dying Scale (FATCOD-B) was developed to detect such a disposition, but its psychometric properties are yet to be clearly defined.

METHOD

A convenience sample of 608 second-year medical students participated in our study in the 2012/2013 and 2013/2014 academic years. All participants completed the FATCOD-B. The sample was randomly divided in two subsamples. In the item analysis, reliability (Cronbach's α), internal consistency (item-total correlations), and an exploratory factor analysis (EFA) were conducted using the first subsample (n = 300). Using the second subsample (n = 308), confirmatory factor analysis (CFA) was performed using the robust ML method in the Lisrel program.

RESULTS

Reliability for all items was 0.699. Item-total correlations, ranging from 0.03 to 0.39, were weak. EFA identified a two-dimensional orthogonal solution, explaining 20% of total variance. CFA upheld the two-dimensional model, but the loadings on the dimensions and their respective indicators were weak and equal to zero for certain items.

SIGNIFICANCE OF RESULTS

The findings of the present study suggest that the FATCOD-B measures a two-dimensional construct and that several items seem in need of revision. Future research oriented toward building a revised version of the scale should pay attention to item ambiguity and take particular care to distinguish among items that concern emotions and beliefs related to end-of-life care, as well as their subjects (e.g., the healthcare provider, the patient, his family).

Attitudes of Medical Students Toward the Care of the Dying in Relation to Personality Traits

Caring for dying patients requires specific attitudes. Medical students often feel unprepared to cope with issues related to end-of-life care. Little is known about the relationships between personality and attitudes toward the dying; consequently, it is difficult for medical educators to devise training that is best suited to prepare students for practicing palliative medicine. The study aimed to investigate the role of personality in predicting students’ attitudes toward the care of the dying. The study findings suggest a significant link between more self-directed and less harm-avoidant personality profiles and more developed attitudes toward the dying. Personality assessment in medical curricula is important, not merely to help teachers plan tailored training but also to foster in future doctors the propensity to develop a patient-centered practice.