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Clemens EJ, Reed JB, Baker ES, Baker CM. Effect of death and dying elective on student empathy and attitudes toward mortality. CURRENTS IN PHARMACY TEACHING & LEARNING 2021; 13:1627-1633. [PMID: 34895672 DOI: 10.1016/j.cptl.2021.09.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 06/30/2021] [Accepted: 09/15/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Pharmacy graduates should be equipped for one inevitable aspect of health care, mortality, yet only 10% of United States pharmacy curricula courses cover end-of-life (EoL) with limited evidence of effectiveness. This study's objective was to evaluate the impact of an EoL elective on student pharmacists' empathy and attitudes toward mortality and caring for terminally ill persons. METHODS First- through third-year student pharmacists enrolled in an EoL elective. Students completed pre- and post-course surveys on self-perceptions of empathy and mortality. Surveys included the following: Kiersma-Chen Empathy Scale (KCES), which assesses empathy of pharmacy and nursing students; revised Collett-Lester Fear of Death and Dying Scale (CL-FODS), which measures fear related to death; and Frommelt Attitudes Toward Care of the Dying Scale Form B (FATCOD-B), which measures health care professionals' attitudes toward EoL care. Anonymous identifiers were used to link pre- and post-course surveys and were collected with an online survey software. Data were analyzed using two-sided paired t-tests. RESULTS Twenty-seven student pharmacists completed the elective. The change in overall mean scores for KCES, CL-FODS, and FATCOD-B correlated with increased empathy, reduced fear of death, and increased positive attitudes toward caring for terminal patients (KCES pre-course = 86.15 vs. post-course = 90.37; CL-FODS pre-course = 93.70 vs. post-course = 75.15; FATCOD-B pre-course = 115.89 vs. post-course = 124.04). CONCLUSIONS After the EoL elective, student empathy and attitudes toward mortality and caring for terminally ill persons improved. Implementing EoL concepts in pharmacy curricula should be explored to better prepare graduates in patient care.
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Affiliation(s)
- Emily J Clemens
- Clinical Pharmacy Specialist, Franciscan Alliance ACO, 700 E Southport Rd., Indianapolis, IN 46227-8553, United States.
| | - Jason B Reed
- Assistant Professor of Library Science, Purdue University Libraries and School of Information Studies, 340 Centennial Mall Drive, West Lafayette, IN 47907-2124, United States.
| | - Emma S Baker
- Purdue College of Pharmacy Third-Year PharmD Student, Purdue University College of Pharmacy, 575 Stadium Mall Drive, West Lafayette, IN 47907-2091, United States.
| | - Chelsea M Baker
- Associate Director of Professional Program Laboratories, Purdue University College of Pharmacy, 575 Stadium Mall Drive, West Lafayette, IN 47907-209, United States.
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Cameron PA, Haddara W. Critical care archetypes. Can J Anaesth 2021; 68:1471-1473. [PMID: 34244901 PMCID: PMC8269398 DOI: 10.1007/s12630-021-02062-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/01/2021] [Accepted: 06/20/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Paul A Cameron
- Department of Medicine Division of Critical Care Medicine, Western University Schulich School of Medicine & Dentistry, 339 Windermere Road, London, ON, N6A5A5, Canada.
| | - Wael Haddara
- Department of Medicine Division of Critical Care Medicine, Western University Schulich School of Medicine & Dentistry, 339 Windermere Road, London, ON, N6A5A5, Canada.,Department of Medicine Division of Critical Care Medicine Division of Endocrinology, Western University Schulich School of Medicine & Dentistry, London, ON, Canada
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Bunin J, Shohfi E, Meyer H, Ely EW, Varpio L. The burden they bear: A scoping review of physician empathy in the intensive care unit. J Crit Care 2021; 65:156-163. [PMID: 34157584 DOI: 10.1016/j.jcrc.2021.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/03/2021] [Accepted: 05/25/2021] [Indexed: 01/09/2023]
Abstract
PURPOSE Research shows that physician empathy can improve patients' reporting of symptoms, participation in care, compliance, and satisfaction; however, success in harnessing these advantages in the ICU hinges on a myriad of contextual factors. This study describes the current state of knowledge about intensivists' empathy. METHODS A scoping review was conducted across six databases and grey literature to clarify intensivists' experiences of empathy and identify directions of future inquiries. The search had no date limits and was specific to empathy, intensivists, and ICU environments. Results were blindly and independently reviewed by authors. RESULTS The search yielded 628 manuscripts; 45 met inclusion criteria. Three overarching themes connected the manuscripts: (1) the risks and benefits of empathy, (2) the spectrum of connection and distance of intensivists from patients/families, and (3) the facilitators and barriers to empathy's development. CONCLUSION Empathy among intensivists is not a dichotomous phenomenon. It instead exists on continua. Four steps are recommended for optimizing empathy in the ICU: clearly defining empathy, addressing risks and benefits transparently, providing education regarding reflective practice, and developing supportive environments. Overall, this review revealed that the state of knowledge about empathy as experienced by intensivists still has room to grow and be further explored.
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Affiliation(s)
- Jessica Bunin
- Department of Medicine, Uniformed Services University of the Health Sciences, USA; Walter Reed National Military Medical Center, USA.
| | - Emily Shohfi
- Walter Reed National Military Medical Center, USA
| | - Holly Meyer
- Department of Medicine, Uniformed Services University of the Health Sciences, USA
| | | | - Lara Varpio
- Department of Medicine, Uniformed Services University of the Health Sciences, USA
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A model for occupational stress amongst paediatric and adult critical care staff during COVID-19 pandemic. Int Arch Occup Environ Health 2021; 94:1721-1737. [PMID: 33630134 PMCID: PMC7905984 DOI: 10.1007/s00420-021-01670-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 02/11/2021] [Indexed: 01/21/2023]
Abstract
Purpose The coronavirus 2019 pandemic has placed all intensive care unit (ICU) staff at increased risk of psychological distress. To date, measurement of this distress has largely been by means of validated assessment tools. We believe that qualitative data may provide a richer view of staff experiences during this pandemic. Methods We conducted a cross-sectional, observational study using online and written questionnaires to all ICU staff which consisted of validated tools to measure psychological distress (quantitative findings) and open-ended questions with free-text boxes (qualitative findings). Here, we report our qualitative findings. We asked four questions to explore causes of stress, need for supports and barriers to accessing supports. A conventional content analysis was undertaken. Results In total, 269 of the 408 respondents (65.9%) gave at least one response to a free-text question. Seven overarching themes were found, which contribute to our proposed model for occupational stress amongst critical care staff. The work environment played an important role in influencing the perceived psychological impact on healthcare workers. Extra-organisational factors, which we termed the “home-work interface” and uncertainty about the future, manifested as anticipatory anxiety, had a proportionally larger influence on worker well-being than would be expected in non-pandemic conditions. Conclusion Our findings have important implications for appropriate allocation of resources and ensuring well-being of the ICU multidisciplinary team for this and future pandemics.
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Tajgardoon M, Cooper GF, King AJ, Clermont G, Hochheiser H, Hauskrecht M, Sittig DF, Visweswaran S. Modeling physician variability to prioritize relevant medical record information. JAMIA Open 2020; 3:602-610. [PMID: 33623894 PMCID: PMC7886572 DOI: 10.1093/jamiaopen/ooaa058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/05/2020] [Accepted: 11/02/2020] [Indexed: 02/05/2023] Open
Abstract
Objective Patient information can be retrieved more efficiently in electronic medical record (EMR) systems by using machine learning models that predict which information a physician will seek in a clinical context. However, information-seeking behavior varies across EMR users. To explicitly account for this variability, we derived hierarchical models and compared their performance to nonhierarchical models in identifying relevant patient information in intensive care unit (ICU) cases. Materials and methods Critical care physicians reviewed ICU patient cases and selected data items relevant for presenting at morning rounds. Using patient EMR data as predictors, we derived hierarchical logistic regression (HLR) and standard logistic regression (LR) models to predict their relevance. Results In 73 pairs of HLR and LR models, the HLR models achieved an area under the receiver operating characteristic curve of 0.81, 95% confidence interval (CI) [0.80-0.82], which was statistically significantly higher than that of LR models (0.75, 95% CI [0.74-0.76]). Further, the HLR models achieved statistically significantly lower expected calibration error (0.07, 95% CI [0.06-0.08]) than LR models (0.16, 95% CI [0.14-0.17]). Discussion The physician reviewers demonstrated variability in selecting relevant data. Our results show that HLR models perform significantly better than LR models with respect to both discrimination and calibration. This is likely due to explicitly modeling physician-related variability. Conclusion Hierarchical models can yield better performance when there is physician-related variability as in the case of identifying relevant information in the EMR.
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Affiliation(s)
- Mohammadamin Tajgardoon
- Intelligent Systems Program, School of Computing and Information, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Gregory F Cooper
- Intelligent Systems Program, School of Computing and Information, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Andrew J King
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Gilles Clermont
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Harry Hochheiser
- Intelligent Systems Program, School of Computing and Information, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Milos Hauskrecht
- Intelligent Systems Program, School of Computing and Information, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Computer Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Dean F Sittig
- Department of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Shyam Visweswaran
- Intelligent Systems Program, School of Computing and Information, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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