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Kim J, Gray JA. Measuring palliative care self-efficacy of intellectual and developmental disability staff using Rasch models. Palliat Support Care 2024; 22:146-154. [PMID: 36683394 DOI: 10.1017/s1478951522001833] [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: 01/24/2023]
Abstract
OBJECTIVES The objectives of this study were to evaluate the psychometric properties of a palliative care self-efficacy instrument developed for intellectual and developmental disability (IDD) staff using Rasch analysis and assess the change in palliative care self-efficacy between 2 time points using Rasch analysis of stacked data. METHODS Staff from 4 nonprofit IDD services organizations in a US Midwestern state (n = 98) answered 11 questions with Likert-style responses at baseline and 1-month follow-up post training. Rasch analysis was performed to examine rating scale structure, unidimensionality, local independence, overall model fit, person and item reliability and separation, targeting, individual item and personal fit, differential item functioning (DIF), and change in palliative care self-efficacy between 2 time points. RESULTS The rating scale structure improved when 5 response categories were collapsed to 3. With the revised 3 response categories, the instrument demonstrated good psychometric properties. Principal components analysis of Rasch residuals supported the assumption of unidimensionality. Model fit statistics indicated an excellent fit of the data to the Rasch model. The instrument demonstrated good person and item reliability and separation. Gender-related DIF was found in 1 item, and work tenure-related DIF in 3 items. Overall palliative care self-efficacy improved between 2 time points. SIGNIFICANCE OF RESULTS Rasch analysis allowed for a more thorough examination of this palliative care self-efficacy instrument than classical test theory and provided information on rating scale structure, targeting, DIF, and individual persons and items. These recommendations can improve this instrument for research and practical contexts.
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Affiliation(s)
- Jinsook Kim
- School of Health Studies, Northern Illinois University, DeKalb, IL, USA
| | - Jennifer A Gray
- School of Health Studies, Northern Illinois University, DeKalb, IL, USA
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2
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Ferguson KA, Reitschuler-Cross EB, Stahl ST. A Multimethod Examination of Medical Students' Experiences With Bereavement and Complicated Grief. OMEGA-JOURNAL OF DEATH AND DYING 2023; 88:668-689. [PMID: 34590884 DOI: 10.1177/00302228211049678] [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: 11/15/2022]
Abstract
Few studies have examined grief in medical students. This study used a multimethod approach to describe how bereavement and CG may impact medical students' educational experience and their perspectives on grief support and training. One hundred three medical students completed an online survey with quantitative and qualitative methods. Seventy-three (71%) students reported experiencing bereavement, of which 12 (18%) screened positive for CG. Medical students who screened positive for CG reported significantly more emotional and behavioral challenges (M = 3.58 [SD = 2.64]) compared to medical students without CG (M = 0.93 [SD = 1.58], p < .001). Qualitative analyses revealed that bereaved and nonbereaved students wanted more grief education and bereavement support from medical institutions. Therefore, it is crucial for medical institutions, to acknowledge that grief and bereavement may impact students' performance due to multifactorial causes.
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Affiliation(s)
- Kortni A Ferguson
- Department of Medicine, University of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Eva B Reitschuler-Cross
- Department of Medicine, University of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Sarah T Stahl
- Department of Psychiatry, University of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
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Tsai FD, Guercio B, Stuver S, Stern R, Peluso MJ, Winkler M, Piawah S, Vallurupalli M, Luskin MR, Braun D, Parent A, Glotzbecker B, Kilbridge KL. Resident-Reported Impact of a Novel Oncology Curriculum for Internal Medicine Residents. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1879-1885. [PMID: 34480712 PMCID: PMC8417651 DOI: 10.1007/s13187-021-02055-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 06/13/2023]
Abstract
The Accreditation Council of Graduate Medical Education mandates that all internal medicine residents gain exposure to internal medicine subspecialties including hematology and oncology. While many residents meet this criterion through inpatient oncology rotations, the current structure of many inpatient oncology rotations leaves little opportunity for formal education. We therefore designed a novel oncology curriculum consisting of one-page oncology teaching sheets to increase the number, breadth, and quality of formal teaching sessions on our resident inpatient oncology services. In order to evaluate the curriculum, we conducted pre- and post-intervention surveys of residents. From these surveys, we found that 72.2% of residents used the teaching sheets on their inpatient oncology rotation and that the teaching sheets led to an increase in the number of formal oncology teaching sessions (mean 3.4 ± 2.1 post-implementation vs 2.6 ± 2.0 pre-implementation, p = 0.008), the breadth of oncology topics taught (% reporting ≥ 5 topics; 26.1% vs 16.3%, p = 0.035), the proportion of residents reporting improvement in overall oncology knowledge (80.2% vs 62.4%, p = 0.012), and the proportion of residents reporting improvement in their ability to care for patients (70.8% vs 48.9%, p = 0.013). These results demonstrate that formal oncology teaching can be improved on inpatient oncology rotations through a simple and easily replicable oncology curriculum.
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Affiliation(s)
- Frederick D Tsai
- Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- Brigham & Women's Hospital, Boston, MA, 02115, USA
| | - Brendan Guercio
- Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Sherri Stuver
- Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- Boston University School of Public Health, Boston University, Boston, MA, 02118, USA
| | - Robert Stern
- Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- Brigham & Women's Hospital, Boston, MA, 02115, USA
| | - Michael J Peluso
- University of California San Francisco Medical Center, San Francisco, CA, 94143, USA
| | | | - Sorbarikor Piawah
- University of California San Francisco Medical Center, San Francisco, CA, 94143, USA
| | - Mounica Vallurupalli
- Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- Brigham & Women's Hospital, Boston, MA, 02115, USA
| | - Marlise R Luskin
- Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- Brigham & Women's Hospital, Boston, MA, 02115, USA
| | - David Braun
- Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- Brigham & Women's Hospital, Boston, MA, 02115, USA
| | - Alexander Parent
- Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- Brigham & Women's Hospital, Boston, MA, 02115, USA
| | - Brett Glotzbecker
- University Hospital Seidman Cancer Center, Cleveland, OH, 44106, USA
| | - Kerry Laing Kilbridge
- Dana-Farber Cancer Institute, Boston, MA, 02215, USA.
- Brigham & Women's Hospital, Boston, MA, 02115, USA.
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA.
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Perera N, Gold M, O'Driscoll L, Katz NT. Goals of Care Discussions Over the Course of a Patient's End of Life Admission: A Retrospective Study. Am J Hosp Palliat Care 2021; 39:652-658. [PMID: 34355578 DOI: 10.1177/10499091211035322] [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: 11/16/2022] Open
Abstract
BACKGROUND As deaths in hospitals increase, clear discussions regarding resuscitation status and treatment limitations, referred to as goals of care (GOC), are vital. GOC may need revision as disease and patient priorities change over time. There is limited data about who is involved in GOC discussions, and how this changes as patients deteriorate in hospital. AIMS To review the timing and clinicians involved in GOC discussions for a cohort of patients who died in hospital. METHODS Retrospective observational audit of 80 consecutive end of life admissions between March 11th and April 9th, 2019. RESULTS Of 80 patients, 75 (93.6%) had GOC recorded during their admission, about half for ward-based non-burdensome symptom management or end-of-life care. GOC were revised in 68.0% of cases. Medical staff involved in initial versus final GOC discussions included home team junior doctor (54.7% versus 72.5%), home team consultant (37.3% versus 56.9%) and ICU doctor (16.0% versus 21.6%). For initial versus final GOC decisions, patients were involved in 34.7% versus 31.4%, and family in 53.3% versus 86.3%. Dying was documented for 92.0% of patients and this was documented to have been communicated to the family and patient in 98.6% and 19.5% of cases respectively. CONCLUSIONS As patients deteriorated, family and senior clinician involvement in GOC discussions increased, but patient involvement did not. Junior doctors were most heavily involved in discussions. We advocate for further GOC training and modeling to enhance junior doctors' confidence and competence in conducting and involving patients and families in GOC conversations.
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Affiliation(s)
- Natalie Perera
- Palliative Care Service, 5392Alfred Health, Melbourne, Victoria, Australia
| | - Michelle Gold
- Palliative Care Service, 5392Alfred Health, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Lisa O'Driscoll
- Advance Care Planning and Improving End of Life Care, 5392Alfred Health, Melbourne, Victoria, Australia
| | - Naomi T Katz
- Palliative Care Service, 5392Alfred Health, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Ioshimoto T, Shitara DI, do Prado GF, Pizzoni R, Sassi RH, de Gois AFT. Education is an important factor in end-of-life care: results from a survey of Brazilian physicians' attitudes and knowledge in end-of-life medicine. BMC MEDICAL EDUCATION 2020; 20:339. [PMID: 33008366 PMCID: PMC7531127 DOI: 10.1186/s12909-020-02253-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 09/23/2020] [Indexed: 06/08/2023]
Abstract
BACKGROUND According to the Latin America Association for palliative care, Brazil offers only 0.48 palliative care services per 1 million inhabitants. In 2012, no accredited physicians were working in palliative care, while only 1.1% of medical schools included palliative care education in their undergraduate curricula. As a reflection of the current scenario, little research about end-of-life care has been published so that studies addressing this subject in the Brazilian setting are crucial. METHODS A cross-sectional study study conducted with students applying for the medical residency of the Federal University of São Paulo were invited to voluntarily participate in an anonymous and self-administered questionnaire survey. The latter included demographic information, attitudes, prior training in end-of-life care, prior end-of-life care experience, the 20-item Palliative Care Knowledge Test (PCKT) and a consent term. RESULTS Of the 3086 subjects applying for residency, 2349 (76%) answered the survey, 2225 were eligible for analysis while 124 were excluded due to incomplete data. Although the majority (99,2%) thought it was important to have palliative care education in the medical curriculum, less than half of them (46,2%) reported having received no education on palliative care. The overall performance in the PCKT was poor, with a mean score of 10,79 (± 3). While philosophical questions were correctly answered (81,8% of correct answers), most participants lacked knowledge in symptom control (50,7% for pain, 57,3% for dyspnea, 52,2% for psychiatric problems and 43,4% for gastrointestinal problems). Doctors that had already concluded a prior residency program and the ones that had prior experience with terminal patients performed better in the PCKT (p < 0,001). The high-performance group (more than 50% of correct answers) had received more training in end-of-life care, showed more interest in learning more about the subject, had a better sense of preparedness, as well as a higher percentage of experience in caring for terminal patients (p < 0,001). CONCLUSIONS Our study showed that Brazilian physicians lack not only the knowledge, but also training in end-of-life medicine. Important factors to better knowledge in end-of-life care were prior training, previous contact with dying patients and prior medical residency. Corroborating the literature, for this group, training showed to be a key factor in overall in this area of knowledge. Therefore, Brazilian medical schools and residency programs should focus on improving palliative training, especially those involving contact with dying patients.
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Affiliation(s)
- Thais Ioshimoto
- Departamento de Medicina. Rua Pedro de Toledo, Universidade Federal de São Paulo (UNIFESP), 719, São Paulo, SP, Brazil
- Hospital Israelita Albert Einstein (HIAE), São Paulo, SP, Brazil
| | - Danielle Ioshimoto Shitara
- Departamento de Medicina. Rua Pedro de Toledo, Universidade Federal de São Paulo (UNIFESP), 719, São Paulo, SP, Brazil
| | - Gilmar Fernades do Prado
- Departamento de Medicina. Rua Pedro de Toledo, Universidade Federal de São Paulo (UNIFESP), 719, São Paulo, SP, Brazil
| | - Raymon Pizzoni
- Departamento de Medicina. Rua Pedro de Toledo, Universidade Federal de São Paulo (UNIFESP), 719, São Paulo, SP, Brazil.
| | - Rafael Hennemann Sassi
- Departamento de Medicina. Rua Pedro de Toledo, Universidade Federal de São Paulo (UNIFESP), 719, São Paulo, SP, Brazil
| | - Aécio Flávio Teixeira de Gois
- Departamento de Medicina. Rua Pedro de Toledo, Universidade Federal de São Paulo (UNIFESP), 719, São Paulo, SP, Brazil
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Wong A, Hsu AT, Tanuseputro P. Assessing attitudes towards medical assisted dying in Canadian family medicine residents: a cross-sectional study. BMC Med Ethics 2019; 20:103. [PMID: 31881966 PMCID: PMC6935122 DOI: 10.1186/s12910-019-0440-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 12/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medical Assistance in Dying (MAID) in Canada came into effect in 2016 with the passing of Bill C-14. As patient interest and requests for MAID continue to evolve in Canada, it is important to understand the attitudes of future providers and the factors that may influence their participation. Attitudes towards physician hastened death (PHD) in general and the specific provision of MAID (e.g., causing death by lethal prescription or injection) are unknown among Canadian residents. This study examined residents' attitudes towards PHD and MAID, and identified factors (e.g., demographics, clinical exposure to death and dying) that may influence their decision to participate in PHD and provide MAID. METHODS A cross-sectional survey was adapted from prior established surveys on MAID to reflect the Canadian setting. All Canadian family medicine programs were invited to participate. The survey was distributed between December 2016 and April 2017. Analysis of the results included descriptive statistics to characterize the survey participants and multivariable logistic regressions to identify factors that may influence residents' attitudes towards PHD and MAID. RESULTS Overall, 247 residents from 6 family medicine training programs in Canada participated (response rate of 27%). While residents were most willing to participate in treatment withdrawal (52%), active participation in PHD (41%) and MAID by prescription of a lethal drug (31%) and lethal injection (24%) were less acceptable. Logistic regressions identified religion as a consistent and significant factor impacting residents' willingness to participate in PHD and MAID. Residents who were not strictly practicing a religion were more likely to be willing to participate in PHD (OR = 17.38, p < 0.001) and MAID (lethal drug OR = 10.55, p < 0.01, lethal injection OR = 8.54, p < 0.05). Increased clinical exposure to death and dying crudely correlated with increased willingness to participate in PHD and MAID, but when examined in multivariable models, only a few activities (e.g., declaring death, completing a death certificate) had a statistically significant association. Other significant factors included the residents' sex and location of training. CONCLUSIONS Residents are hesitant to provide MAID themselves, with religious faith being a major factor impacting their decision.
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Affiliation(s)
- Aaron Wong
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Amy T Hsu
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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7
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Peh TY, Yang GM, Krishna LKR, Yee ACP. Do Doctors Gain More Confidence from a Longer Palliative Medicine Posting? J Palliat Med 2017; 20:141-146. [DOI: 10.1089/jpm.2016.0293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Tan Ying Peh
- Division of Palliative Medicine, National Cancer Centre Singapore, Singapore
| | - Grace Meijuan Yang
- Division of Palliative Medicine, National Cancer Centre Singapore, Singapore
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8
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George NR, Kryworuchko J, Hunold KM, Ouchi K, Berman A, Wright R, Grudzen CR, Kovalerchik O, LeFebvre EM, Lindor RA, Quest TE, Schmidt TA, Sussman T, Vandenbroucke A, Volandes AE, Platts-Mills TF. Shared Decision Making to Support the Provision of Palliative and End-of-Life Care in the Emergency Department: A Consensus Statement and Research Agenda. Acad Emerg Med 2016; 23:1394-1402. [PMID: 27611892 DOI: 10.1111/acem.13083] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 08/29/2016] [Accepted: 09/07/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Little is known about the optimal use of shared decision making (SDM) to guide palliative and end-of-life decisions in the emergency department (ED). OBJECTIVE The objective was to convene a working group to develop a set of research questions that, when answered, will substantially advance the ability of clinicians to use SDM to guide palliative and end-of-life care decisions in the ED. METHODS Participants were identified based on expertise in emergency, palliative, or geriatrics care; policy or patient-advocacy; and spanned physician, nursing, social work, legal, and patient perspectives. Input from the group was elicited using a time-staggered Delphi process including three teleconferences, an open platform for asynchronous input, and an in-person meeting to obtain a final round of input from all members and to identify and resolve or describe areas of disagreement. CONCLUSION Key research questions identified by the group related to which ED patients are likely to benefit from palliative care (PC), what interventions can most effectively promote PC in the ED, what outcomes are most appropriate to assess the impact of these interventions, what is the potential for initiating advance care planning in the ED to help patients define long-term goals of care, and what policies influence palliative and end-of-life care decision making in the ED. Answers to these questions have the potential to substantially improve the quality of care for ED patients with advanced illness.
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Affiliation(s)
- Naomi R. George
- Department of Emergency Medicine; Brown University; Providence RI
| | | | | | - Kei Ouchi
- Department of Emergency Medicine; Brigham and Women's Hospital; Boston MA
| | - Amy Berman
- Hartford Program Officer/Patient Representative; New York NY
| | - Rebecca Wright
- Department of Emergency Medicine; NYU School of Medicine; New York NY
| | - Corita R. Grudzen
- Department of Emergency Medicine; NYU School of Medicine; New York NY
| | | | - Eric M. LeFebvre
- Department of Emergency Medicine, Geriatric Fellow; University of North Carolina-Chapel Hill; Chapel Hill NC
| | | | - Tammie E. Quest
- Department of Emergency Medicine; Emory University; Atlanta GA
| | - Terri A. Schmidt
- Departments of Emergency Medicine and Hematology/Oncology; Oregon Health and Science University; Portland OR
| | - Tamara Sussman
- School of Social Work; McGill University; Montreal Quebec Canada
| | | | | | - Timothy F. Platts-Mills
- Department of Emergency Medicine and Department of Anesthesiology; University of North Carolina-Chapel Hill; Chapel Hill NC
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Frey R, Powell L, Gott M. “Both sides now”—A scale for assessing health care providers’ intercultural communication comfort regarding traditional and non-traditional palliative care. Eur J Integr Med 2016. [DOI: 10.1016/j.eujim.2015.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Kawaguchi S, Mirza R, Nissim R, Ridley J. Internal Medicine Residents' Beliefs, Attitudes, and Experiences Relating to Palliative Care: A Qualitative Study. Am J Hosp Palliat Care 2016; 34:366-372. [PMID: 26843534 DOI: 10.1177/1049909116628799] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Internal medicine residents are frequently called upon to provide palliative care to hospitalized patients, but report feeling unprepared to do so effectively. Curricular development to enhance residents' palliative care skills and competencies requires an understanding of current beliefs, attitudes and learning priorities. METHODS We conducted a qualitative study consisting of semi-structured interviews with ten internal medicine residents to explore their understanding of and experiences with palliative care. RESULTS All of the residents interviewed had a sound theoretical understanding of palliative care, but faced many challenges in being able to provide care in practice. The challenges described by residents were system-related, patient-related and provider-related. They identified several priority areas for further learning, and discussed ways in which their current education in palliative care could be enhanced. CONCLUSIONS Our findings provide important insights to guide curricular development for internal medicine trainees. The top five learning priorities in palliative care that residents identified in our study were: 1) knowing how and when to initiate a palliative approach, 2) improving communication skills, 3) improving symptom management skills, 4) identifying available resources, and 5) understanding the importance of palliative care. Residents felt that their education in palliative care could be improved by having a mandatory rotation in palliative care, more frequent didactic teaching sessions, more case-based teaching from palliative care providers, opportunities to be directly observed, and increased support from palliative care providers after-hours.
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Affiliation(s)
- S Kawaguchi
- 1 Division of Palliative Care, Department of Family and Community Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - R Mirza
- 2 Faculty of Medicine, Institute for Life Course and Aging, University of Toronto, Toronto, Ontario, Canada
| | - R Nissim
- 3 Department of Psychosocial Oncology and Palliative Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - J Ridley
- 4 Division of Palliative Care, Department of Family and Community Medicine, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
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The effectiveness of communication-skills training interventions in end-of-life noncancer care in acute hospital-based services: A systematic review. Palliat Support Care 2015; 14:433-44. [PMID: 26675418 DOI: 10.1017/s1478951515001108] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE A systematic review was conducted in order to explore the effectiveness of communication-skills training interventions in end-of-life care with noncancer acute-based healthcare staff. METHOD Articles were included if they (1) focused on communication-skills training in end-of-life/palliative care for noncancer acute-based staff and (2) reported an outcome related to behavior change with regard to communication. Sixteen online databases were searched, which resulted in 4,038 potential articles. Screening of titles left 393 articles that met the inclusion criteria. Abstracts (n = 346) and full-text articles (n = 47) were reviewed, leaving 10 papers that met the criteria for our review. All articles explored the effect of communication-skills training on aspects of staff behavior; one study measured the effect on self-efficacy, another explored the impact on knowledge and competence, and another measured comfort levels in discussing the end of life with patients/families. Seven studies measured a number of outcomes, including confidence, attitude, preparedness, stress, and communication skills. RESULTS Few studies have focused on end-of-life communication-skills training in noncancer acute-based services. Those that do have report positive effects on staff behavior with regard to communication about the end of life with patients and families. The studies varied in terms of the population studied and the health services involved, and they scored only moderately or weakly on quality. It is a challenge to draw a definite conclusion about the effectiveness of training interventions in end-of-life communication because of this. However, the findings from our review demonstrate the potential effectiveness of a range of training interventions with healthcare professionals on confidence, attitude, self-efficacy, and communication skills. SIGNIFICANCE OF RESULTS Further research is needed to fully explore the effectiveness of existing training interventions in this population, and evidence using objective measures is particularly needed. Ideally, randomized controlled trials or studies using control groups and longer follow-ups are needed to test the effectiveness of interventions.
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12
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Forster E, Hafiz A. Paediatric death and dying: exploring coping strategies of health professionals and perceptions of support provision. Int J Palliat Nurs 2015; 21:294-301. [PMID: 26126678 DOI: 10.12968/ijpn.2015.21.6.294] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
UNLABELLED Without question a child's death is a devastating event for parents and families. Health professionals working with the dying child and family draw upon their expertise and experience to engage with children, parents and families on this painful journey. This is a delicate and sensitive area of practice and has strong and penetrating effects on health professionals. They employ physical, emotional, spiritual and problem solving strategies to continue to perform this role effectively and to protect their continued sense of wellbeing. AIM To explore health professionals' perceptions of bereavement support surrounding the loss of a child. METHODS The research was underpinned by social constructionism. Semi-structured interviews were held with 10 health professionals including doctors, nurses and social workers who were directly involved in the care of the dying child and family in 7 cases of paediatric death. Health professional narratives were analysed consistent with Charmarz's (2006) approach. RESULTS For health professionals, constructions around coping emerged as peer support, personal coping strategies, family support, physical impact of support and spiritual beliefs. Analysis of the narratives also revealed health professionals' perceptions of their support provision. CONCLUSION Health professionals involved in caring for dying children and their families use a variety of strategies to cope with the emotional and physical toll of providing support. They also engage in self-assessment to evaluate their support provision and this highlights the need for self-evaluation tools in paediatric palliative care.
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Affiliation(s)
| | - Alaa Hafiz
- PhD Student, School of Nursing, Faculty of Health Queensland University of Technology, Brisbane, Australia
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13
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Chan WCH, Tin AF, Wong KLY. Coping With Existential and Emotional Challenges: Development and Validation of the Self-Competence in Death Work Scale. J Pain Symptom Manage 2015; 50:99-107. [PMID: 25701687 DOI: 10.1016/j.jpainsymman.2015.02.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 02/02/2015] [Accepted: 02/14/2015] [Indexed: 10/24/2022]
Abstract
CONTEXT Palliative care professionals often are confronted by death in their work. They may experience challenges to self, such as aroused emotions and queries about life's meaningfulness. Assessing their level of "self-competence" in coping with these challenges is crucial in understanding their needs in death work. OBJECTIVES This study aims to develop and validate the Self-Competence in Death Work Scale (SC-DWS). METHODS Development of this scale involved three steps: 1) items generated from a qualitative study with palliative care professionals, (2) expert panel review, and (3) pilot test. Analysis was conducted to explore the factor structure and examine the reliability and validity of the scale. Helping professionals involved in death work were recruited to complete questionnaires comprising the SC-DWS and other scales. RESULTS A total of 151 participants were recruited. Both one-factor and two-factor structures were found. Emotional and existential coping were identified as subscales in the two-factor structure. Correlations of the whole scale and subscales with measures of death attitudes, meaning in life, burnout and depression provided evidence for the construct validity. Discriminative validity was supported by showing participants with bereavement experience and longer experience in the profession and death work possessed a significantly higher level of self-competence. Reliability analyses showed that the entire scale and subscales were internally consistent. CONCLUSION The SC-DWS was found to be valid and reliable. This scale may facilitate helping professionals' understanding of their self-competence in death work, so appropriate professional support and training may be obtained.
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Affiliation(s)
- Wallace Chi Ho Chan
- Department of Social Work, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Agnes Fong Tin
- Center on Behavioral Health, The University of Hong Kong, Hong Kong SAR, China
| | - Karen Lok Yi Wong
- Department of Social Work, The Chinese University of Hong Kong, Hong Kong SAR, China
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Loucka M, Pasman RH, Brearley SG, Payne SA, Onwuteaka-Philipsen B. Self-reported knowledge, attitudes, and behaviour towards hospice care and how are these related to training in palliative care: An online survey among oncologists in the Czech Republic and Slovakia. PROGRESS IN PALLIATIVE CARE 2015. [DOI: 10.1179/1743291x13y.0000000067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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De Witt Jansen B, Weckmann M, Nguyen CM, Parsons C, Hughes CM. A cross-national cross-sectional survey of the attitudes and perceived competence of final-year medicine, nursing and pharmacy students in relation to end-of-life care in dementia. Palliat Med 2013; 27:847-54. [PMID: 23612960 DOI: 10.1177/0269216313483661] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Little is known about the attitudes of healthcare professional students' perceived competence and confidence in treating those with dementia who are at the end of life. AIM To explore the attitudes of final year medical, nursing and pharmacy students towards people with dementia and to evaluate their perceived competence and confidence dealing with biomedical and psychosocial issues within the context of palliative care provision to patients with dementia. DESIGN Cross-sectional survey using a questionnaire. SETTING/PARTICIPANTS Final-year students in each profession from Queen's University Belfast (Northern Ireland) and the University of Iowa (USA) were recruited. METHOD Three versions of an online questionnaire (containing the Attitudes to Dementia Questionnaire and a series of questions on end-of-life care in dementia) were distributed. RESULTS A total of 368 responses were received (response rate 42.3%). All respondents reported positive attitudes towards people with dementia. US nursing students reported significantly more positive attitudes than the medical students of United States and Northern Ireland. Medical students were more likely to report low confidence in discussing non-medical aspects of dying, whereas nursing students were most likely to feel prepared and confident to do this. Medical and nursing students reported low confidence with aspects of medication-related care; however, data from the pharmacy samples of Northern Ireland and United States suggested that these students felt confident in advising other healthcare professionals on medication-related issues. CONCLUSIONS While healthcare students hold positive attitudes towards people with dementia, some clinical tasks remain challenging and further basic training may be of benefit.
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dos Santos MA, Aoki FCDOS, de Oliveira-Cardoso EA. [The significance of death for doctors faced with end-of-life care of patients undergoing bone marrow transplants]. CIENCIA & SAUDE COLETIVA 2013; 18:2625-34. [PMID: 23989569 DOI: 10.1590/s1413-81232013000900017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 05/22/2013] [Indexed: 11/22/2022] Open
Abstract
This study sought to investigate the significance of death for doctors who work with terminally ill patients in the Bone Marrow Transplant (BMT) context. The research was based on a qualitative, methodological and collective case study approach, and used Dejours' psychodynamics of work as a theoretical framework. Five practitioners linked to a Bone Marrow Transplant Unit in a university hospital in São Paulo, Brazil, participated in the research. A semi-structured script was applied which addressed the personal, academic and professional experiences elicited by a terminal situation. Data were organized into two categories: "Work and professional identity: the doctor's battle against death" and "Vocation and medical training: it all begins at home." The results show that, in the medical and hospital context, death is almost always reduced to technical rationality and this must be avoided at all costs. The significances attributed to death are rooted in the values of contemporary society and subjectively perceived through the physician's life trajectory and academic training, which influence how these professionals experience the dying process of the patients.
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Affiliation(s)
- Manoel Antônio dos Santos
- Departamento de Psicologia, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo, Av. Bandeirantes 3900, Monte Alegre, 14.040-901 Ribeirão Preto SP, Brazil.
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Frey R, Powell L, Gott M. Care vs. care: ‘Biomedical’ and ‘holistic’ worldviews of palliative care. Eur J Integr Med 2013. [DOI: 10.1016/j.eujim.2013.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Frey R, Gott M, Banfield R. What indicators are measured by tools designed to address palliative care competence among ‘generalist’ palliative care providers? A critical literature review. PROGRESS IN PALLIATIVE CARE 2013. [DOI: 10.1179/1743291x11y.0000000003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Pfister D, Markett S, Müller M, Müller S, Grützner F, Rolke R, Kern M, Schmidt-Wolf G, Radbruch L. German nursing home professionals' knowledge and specific self-efficacy related to palliative care. J Palliat Med 2013; 16:794-8. [PMID: 23701034 DOI: 10.1089/jpm.2012.0586] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In Germany, more and more terminally ill patients spend their last days of life in nursing homes, and this presents a challenge for these institutions. Even though palliative care is a growing domain in health care, no quantitative in-depth evaluations of the status quo in nursing homes has been conducted so far in Germany, partly because of lacking measuring tools. OBJECTIVE This study used a new questionnaire to assess German health care professionals' theoretical knowledge of palliative care and their perceived self-efficacy. Both variables have been proven to be indicators for the quality of the implementation of palliative care in nursing homes. METHODS We used the Bonn Palliative Care Knowledge Test (Bonner Palliativwissenstest, BPW) questionnaire to measure knowledge of palliative care in the domains of medicine, care, and psychosocial care and to measure self-efficacy relating to palliative care. RESULTS Care workers (N=130) in five nursing homes in the region of Aachen in western Germany answered the questionnaires. The results show low knowledge (on average 52.8% correct answers) and self-efficacy relating to palliative care, although work with dying people is their daily challenge. While general knowledge correlated with work experience, a negative correlation of specific self-efficacy with age and working experience was observed. CONCLUSIONS Lower self-efficacy of care workers experienced in palliative care probably implies that the difficulty of palliative care skills is underestimated by inexperienced care workers. Palliative care training is urgently needed to improve knowledge and self-efficacy. Guidance to assist care professionals involved in palliative care in nursing homes needs to be developed and provided.
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Pulsford D, Jackson G, O'Brien T, Yates S, Duxbury J. Classroom-based and distance learning education and training courses in end-of-life care for health and social care staff: a systematic review. Palliat Med 2013; 27:221-35. [PMID: 22126845 DOI: 10.1177/0269216311429496] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Staff from a range of health and social care professions report deficits in their knowledge and skills when providing end-of-life and palliative care, and education and training has been advocated at a range of levels. AIMS To review the literature related to classroom-based and distance learning education and training initiatives for health and social care staff in end-of-life and palliative care, in terms of their target audience, extent, modes of delivery, content and teaching and learning strategies, and to identify the most effective educational strategies for enhancing care. DESIGN A systematic review of the literature evaluating classroom-based and distance learning education and training courses for health and social care staff in end-of-life and palliative care. DATA SOURCES Online databases CINAHL, MEDLINE, EMBASE and PSYCHINFO between January 2000 and July 2010. Studies were selected that discussed specific education and training initiatives and included pre-and post-test evaluation of participants' learning. RESULTS 30 studies met eligibility criteria. The majority reported successful outcomes, though there were some exceptions. Level of prior experience and availability of practice reinforcement influenced learning. Participative and interactive learning strategies were predominantly used along with discussion of case scenarios. Multi-professional learning was infrequently reported and service user and carer input to curriculum development and delivery was reported in only one study. CONCLUSIONS Classroom-based education and training is useful for enhancing professionals' skills and perceived preparedness for delivering end-of-life care but should be reinforced by actual practice experience.
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Affiliation(s)
- David Pulsford
- School of Health, University of Central Lancashire, Preston, UK.
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Smith L, O'Sullivan P, Lo B, Chen H. An educational intervention to improve resident comfort with communication at the end of life. J Palliat Med 2012; 16:54-9. [PMID: 23030260 DOI: 10.1089/jpm.2012.0173] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Approximately 20% of deaths in the United States occur in the intensive care unit (ICU). Physician trainees lack the practical communication skills required for end-of-life care, including establishing patient preferences, participating in shared decision making, discussing prognosis, and delivering bad news. Utilizing facilitated, case-based, peer interactions, we sought to assess the feasibility and impact of a novel resident curriculum in end-of-life education. METHODS The study took place at each of the three University of California, San Francisco (UCSF) teaching hospitals, and involved all internal medicine residents at UCSF. The curriculum consisted of two one-hour lunch conference sessions and six one-hour morning reports. A pre- and post-intervention electronic survey was administered. RESULTS AND DISCUSSION The teaching sessions offered in this study were well-attended and well-received by residents. Our curriculum impacted resident reports of comfort with specific topics in end-of-life care, including discussions of code status and comfort care. Furthermore, we found that this curriculum, although brief, demonstrated a small impact on resident reports of self-efficacy for communication. Our findings demonstrate the feasibility of incorporating end-of-life communication skills training into an existing internal medicine resident curriculum.
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Affiliation(s)
- Leah Smith
- University of California, San Francisco, San Francisco, California 94143, USA.
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Smith L, Hough CL. Using death rounds to improve end-of-life education for internal medicine residents. J Palliat Med 2011; 14:55-8. [PMID: 21244254 DOI: 10.1089/jpm.2010.0190] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
UNLABELLED While internal medicine interns provide much of the care to patients dying in the hospital, few report that they have received adequate training in end-of-life care. PURPOSE To address this perceived lack of training, we undertook a study to evaluate Death Rounds as an educational tool in end-of-life care and to address the emotional needs of trainees providing care to dying patients. DESIGN We used a behavioral interventional study using a pre-post study design. PARTICIPANTS The study included all internal medicine interns at the University of Washington (n = 62) during the academic year 2007-08. Interns from the 2006-07 academic year (n = 64) received the survey and served as the control group. INTERVENTION Death Rounds, a one-hour session dedicated to discussion of emotional reactions to patient death. MAIN MEASURES We used a 14-item electronic measure with questions directed toward the impact of perceived insufficient end-of-life care and the role of Death Rounds in resident education. KEY RESULTS Results are drawn from a total of 39 surveys completed by the intervention group, for a response rate of 63%. Seventy-four percent (29) felt that Death Rounds contributed to their education in end-of-life issues. Seventy-two percent (28) reported that Death Rounds was "somewhat" or "very" helpful in improving their comfort with discussing end-of-life issues. Ninety-seven percent (38) of participants thought that having an opportunity to discuss the emotional aspects of patient death should be included in their training. CONCLUSIONS This study suggests that learning to deal with the strong emotions that arise in the care of dying patients is an important part of physician training. Death Rounds provides an opportunity to explore these emotions with colleagues in a supportive environment and is a valuable addition to the resident curriculum.
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Affiliation(s)
- Leah Smith
- Pulmonary/Critical Care, University of California San Francisco, San Francisco, California, USA.
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Structured teaching versus experiential learning of palliative care for surgical residents. Am J Surg 2010; 200:542-7. [DOI: 10.1016/j.amjsurg.2009.12.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Revised: 11/29/2009] [Accepted: 12/08/2009] [Indexed: 11/18/2022]
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Becker G, Momm F, Deibert P, Xander C, Gigl A, Wagner B, Baumgartner J. Planning training seminars in palliative care: a cross-sectional survey on the preferences of general practitioners and nurses in Austria. BMC MEDICAL EDUCATION 2010; 10:43. [PMID: 20540757 PMCID: PMC2893516 DOI: 10.1186/1472-6920-10-43] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Accepted: 06/11/2010] [Indexed: 05/29/2023]
Abstract
BACKGROUND Training in palliative care is frequently requested by health care professionals. However, little is known in detail about the subject matters and the educational preferences of physicians and staff or assistant nurses in this field. METHODS All 897 registered GPs and all 933 registered home care nurses in the district of Steiermark/Austria were sent postal questionnaires. RESULTS Results from 546 (30%) respondents revealed that GPs prefer evening courses and weekend seminars, whereas staff and assistant nurses prefer one-day courses. Multidisciplinary sessions are preferred by almost 80% of all professional groups. GPs preferred multi disciplinary groups most frequently when addressing psychosocial needs (88.8%) and ethical questions (85.8%). Staff and assistant nurses preferred multidisciplinary groups most frequently in the area of pain management (88%) and opted for multi disciplinary learning to a significantly higher extent than GPs (69%; p < 0.01). Those topics were ranked first which are not only deepening, but supplementing the professional training. On average, GPs were willing to spend a maximum amount of euro 400 per year for training seminars in palliative care, whereas nurses would spend approximately euro 190 for such classes.The results provide a detailed analysis of the preferences of GPs and nurses and offer guidance for the organisation of training seminars in palliative care. CONCLUSIONS Medical and nursing education programs often pursue separate paths. Yet our findings indicate that in palliative care multidisciplinary training seminars are favoured by both, doctors and nurses. Also, both groups prefer topics that are not only deepening, but supplementing their professional knowledge.
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Affiliation(s)
- Gerhild Becker
- Department of Internal Medicine II, University Medical Center Freiburg, Freiburg, Germany
- Palliative Care Research Group, University Medical Center Freiburg, Freiburg, Germany
| | - Felix Momm
- Palliative Care Research Group, University Medical Center Freiburg, Freiburg, Germany
| | - Peter Deibert
- Palliative Care Research Group, University Medical Center Freiburg, Freiburg, Germany
| | - Carola Xander
- Palliative Care Research Group, University Medical Center Freiburg, Freiburg, Germany
| | - Annemarie Gigl
- Red Cross Austria, National Association Styria, Graz, Austria
| | - Brigitte Wagner
- External consultantions for Socioscientific Studies, Methodology and Statistics Graz, Austria
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Mas C, Albaret MC, Sorum PC, Mullet E. French general practitioners vary in their attitudes toward treating terminally ill patients. Palliat Med 2010; 24:60-7. [PMID: 19797340 DOI: 10.1177/0269216309107012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study is to analyze French general practitioners' attitudes toward prescribing opiate painkillers for dying patients and compare them with their attitudes toward making frequent home visits. One hundred and fifteen general practitioners indicated the acceptability of prescribing opiates in 48 scenarios of terminal cancer patients with different levels of age, gender, stated pain, request for painkillers, and signs of depression; 103 of them also indicated the acceptability of making frequent home visits in the same 48 scenarios. The responses were analyzed using analysis of variance and cluster analysis. For prescribing opiates, four clusters of physicians were found: 13 prescribed primarily in response to stated pain; 43 to request for painkillers; 43 to the combination of pain, request, and depression; and 16 in virtually all cases. Using the same clusters to analyze visiting gave results that were very consistent with those for prescribing. We conclude that French general practitioners have differing and consistent styles in prescribing painkillers and making home visits to dying cancer patients.
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Affiliation(s)
- Céline Mas
- University of Rangueil, Toulouse, France
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