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Rusch R, Coats H, Wallace CL, Johnson KA, Lockman K, Rosa WE, Wright R, DeSanto-Madeya S, Wu DS. The Palliative Arts: Envisioning a New Paradigm in Palliative Care. J Palliat Med 2025; 28:10-17. [PMID: 39527268 DOI: 10.1089/jpm.2024.0279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2024] Open
Abstract
A growing body of evidence supports the effectiveness of arts-based interventions in nurturing human connection, healing, and reflection-for patients living with illness, their families, and their health care communities. Thus, we propose that these interventions, what we call the Palliative Arts-just as much as science-should be systematically integrated in clinical education, practice, research, wellness, leadership, and advocacy to impact person-centered outcomes. Our interprofessional team describes a variety of arts-based programming that its authors are leading to highlight the breadth of existing Palliative Arts work and point to future horizons for its integration in health care education and clinical settings. We propose that the Palliative Arts can inform a new paradigm, one with the potential to foster person-centered innovation and meaningful change in the field of palliative care-and health care at large.
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Affiliation(s)
- Rachel Rusch
- Pediatric Palliative Medicine, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Heather Coats
- Section of Adolescent Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Hospice and Palliative Nurses Association, Carnegie, Pennsylvania, USA
| | - Cara L Wallace
- Trudy Busch Valentine School of Nursing, Saint Louis University, St. Louis, Missouri, USA
| | - Khaliah A Johnson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - William E Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Rebecca Wright
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - Susan DeSanto-Madeya
- College of Nursing, University of Rhode Island, South Kingstown, Rhode Island, USA
| | - David S Wu
- Johns Hopkins Bayview Palliative Care Program, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Wright R, Chapla K, Booth A, Nelson KE, Peeler A, Swain C, Won S, Wu DS. Enhancing Rigor, Quality, and Patient Engagement in Qualitative Research: A Step-By-Step Guide to Applying Reflexive Thematic Analysis to the Experience-Based Co-Design Methodology. QUALITATIVE HEALTH RESEARCH 2024:10497323241291798. [PMID: 39667075 DOI: 10.1177/10497323241291798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2024]
Abstract
Experience-based co-design (EBCD) is a qualitative form of participatory action research supported by a toolkit providing guidance and recommendations. The toolkit is intentionally non-prescriptive, allowing EBCD practitioners the freedom to flex the approach to cater to the needs of their specific populations and contexts. For less experienced researchers, the lack of specificity can be a challenge when navigating activities such as data analysis, particularly as wider literature provides limited insights to methods, processes, methodological critique, and lessons learned. Despite increasing use of EBCD, few practitioners publish details of their methods, processes, or decision-making for how they adapt EBCD for their studies, focusing more often on findings and outcomes. This can impact understanding and development of rigor in EBCD literature. In this methodology paper, we respond to this gap by providing a case example and step-by-step guide for application of reflexive thematic analysis to EBCD, with consideration of reflexivity, a conceptual framing for interpreting experiences, opportunities for greater participant involvement, and strengths and challenges of using reflexive thematic analysis within EBCD.
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Affiliation(s)
| | - Kavita Chapla
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ashley Booth
- Johns Hopkins Bayview Palliative Care Program, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Katie E Nelson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Anna Peeler
- Cicely Saunders Institute of Palliative Care, Policy, and Rehabilitation, King's College London, London, UK
| | - Christy Swain
- Johns Hopkins Bayview Palliative Care Program, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Sarah Won
- Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - David S Wu
- Johns Hopkins Bayview Palliative Care Program, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Lanocha N, Taub S, Webb JA, Wood M, Tate T. It Starts With a Story: A Four-Step Narrative-Based Framework for Serious Illness Conversations. J Palliat Med 2024; 27:1177-1183. [PMID: 38968377 DOI: 10.1089/jpm.2024.0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2024] Open
Abstract
Background: As a key component of advance care planning, serious illness conversations form a core intervention in palliative care. To achieve effective serious illness conversations, acknowledgment and inclusion of patient sense of self and identity are critical. However, no framework exists to describe how goals, values, and choices relate to patient identity. This conceptual gap hinders the advancement of palliative care education and practice. Objective: This philosophical investigation aimed to explicate two items: first, a novel conceptual framework for serious illness conversations; second, a structured approach to optimize these conversations within the palliative care clinical context. Methods: A philosophical and theoretical analysis was performed within an interdisciplinary context, by scholars in palliative care, medical humanities, philosophy, and bioethics. Key literature in psychology, qualitative research on the experience of serious illness, medical ethics, and choice architecture in medical decision-making were reviewed, and a structured conceptual and narrative analysis was performed. Results: An original and innovative identity-centered conceptual framework for serious illness conversations was developed. The framework consists of a four-step, reproducible approach: (1) attend to patient narrative identity, (2) identify values, (3) cocreate goals, and (4) actively promote choices. In short: attend, identify, create, and promote (AICP). Discussion: By using this conceptual framework and four-step approach, clinicians can accomplish goal-concordant serious illness care and build rich clinical relationships that foster trust and goodwill.
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Affiliation(s)
| | - Sara Taub
- Knight Cancer Institute, Portland, Oregon, USA
| | - Jason A Webb
- Oregon Health and Science University, Portland, Oregon, USA
- University of Oregon, Eugene, Oregon, USA
| | - Mary Wood
- University of Oregon, Eugene, Oregon, USA
| | - Tyler Tate
- Stanford University School of Medicine, Palo Alto, California, USA
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Wilcox S, Saunders RP, Stucker J, Kaczynski AT, Day KR, Kinnard D, Decker L, Bernhart JA. A process for converting an in-person training to increase church capacity to implement physical activity and healthy eating practices and policies to an online format. Transl Behav Med 2023; 13:226-235. [PMID: 36688468 PMCID: PMC10105879 DOI: 10.1093/tbm/ibac102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
The implementation of evidence-based public health programs into practice is critical for improving health, but trainings for organizational change agents are often not scalable. To describe the process of converting a training that targets faith-based organizational capacity development from an in-person to an online format. We engaged in an iterative process to convert the training delivery mode from in-person to online that included assessing stakeholder support, consulting the literature on best practices, seeking a design team, consolidating content, designing engaging lessons, and building an online site. Feedback from end-users and other audiences was incorporated throughout. Pilot participants with characteristics like intended training users were then recruited via community and faith-based partner networks. They rated their agreement with statements about the effectiveness as well as design and functionality of each lesson and the overall training (1 = strongly disagree, 5 = strongly agree) and participated in a structured follow-up interview. Nine pilot participants (representing 9 churches in 7 states; 6 African American, 5 with health ministries) rated the online lessons favorably (all ratings ≥ 4.5). Most (90.4%) perceived the lesson duration to be "just right" and spent 52.5 ± 9.9 minutes/lesson. Participants evaluated the overall training positively (all ratings ≥ 4.7). Lesson content, resources, multimedia, and program ideas were most-liked aspects of lessons, while content, staff responsiveness, discussion board, and pace were most-liked aspects of the overall training in open-ended and interview responses. This paper shares a replicable process for converting training modalities from in-person to online with the goal of increased scalability.
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Affiliation(s)
| | - Ruth P Saunders
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Jessica Stucker
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Andrew T Kaczynski
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Kelsey R Day
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Deborah Kinnard
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Lindsay Decker
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - John A Bernhart
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
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Balhara KS, Irvin N, Zink KL, Mohan S, Olson AS, Tackett S, Emergency Medicine Education Research Alliance (EMERA), Regan L. "A sorely neglected field": A multisite study of self-reported humanities exposure among emergency medicine residents. AEM EDUCATION AND TRAINING 2022; 6:e10772. [PMID: 35784381 PMCID: PMC9242415 DOI: 10.1002/aet2.10772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 06/15/2023]
Abstract
Background The Association of American Medical Colleges has identified the humanities as fundamental to medical education across all specialties. Evidence from undergraduate medical education (UME) demonstrates the humanities' positive impacts on outcomes that could be relevant to patient care and trainee well-being in emergency medicine (EM) residency training. However, less is known about the humanities' role in graduate medical education (GME). Objectives The objectives were to describe EM residents' self-reported exposure to the humanities and its relationship with their empathy, tolerance of ambiguity, and patient-centeredness, and to assess their attitudes toward the humanities in GME. Methods This cross-sectional survey-based study was conducted at six U.S. EM residency programs in 2018-2019. Quantitative analyses included linear regressions testing for trends between humanities exposures and outcomes, adjusted for sex, year in training, and clustering within programs; adjunct analysis of free-text responses was performed using an exploratory constructivist approach to identify themes about views on the humanities' role in medicine. Results Response rate was 54.8% (153/279). A total of 65% of respondents were male and 28.1% of respondents had a preceding humanities degree. Preceding humanities degree and current self-reported humanities exposure were positively associated with performance on empathy subscales (p = 0.02). Seventy-five percent (n = 114) of respondents agreed humanities are important in GME; free-text responses revealed perceived positive impacts of humanities on generating well-rounded clinicians and enhancing patient care. Conclusions Engagement with the humanities may be associated with empathy among EM residents. Although the magnitude of associations was smaller than that seen in UME, this study demonstrates resident interest in humanities and suggests that extracurricular engagement with the humanities may be insufficient to prolong positive impacts seen in UME. Further research is needed to explore how to sustain these benefits through integration or addition of the humanities in existing GME curricula.
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Affiliation(s)
- Kamna S. Balhara
- Department of Emergency MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Nathan Irvin
- Department of Emergency MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Korie L. Zink
- Department of Emergency MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Sanjay Mohan
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency MedicineNYU Grossman School of MedicineNew YorkNew YorkUSA
| | - Adriana S. Olson
- Section of Emergency Medicine, Department of MedicineUniversity of ChicagoChicagoIllinoisUSA
| | - Sean Tackett
- Division of General Internal MedicineJohns Hopkins Bayview Medical CenterBaltimoreMarylandUSA
- Biostatistics Epidemiology and Data Management CoreJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | | | - Linda Regan
- Department of Emergency MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
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