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Thompson AL, Schaefer MR, McCarthy SR, Hildenbrand AK, Cousino MK, Marsac ML, Majeski J, Wohlheiter K, Kentor RA. Competencies for Psychology Practice in Pediatric Palliative Care. J Pediatr Psychol 2023:7152461. [PMID: 37141582 DOI: 10.1093/jpepsy/jsad007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/10/2023] [Accepted: 01/29/2023] [Indexed: 05/06/2023] Open
Abstract
OBJECTIVE Pediatric psychologists have unique expertise to contribute to the care of youth with serious illnesses yet are not routinely integrated into pediatric palliative care (PPC) teams. To better define the role and unique skillset of psychologists practicing in PPC, support their systematic inclusion as part of PPC teams, and advance trainee knowledge of PPC principles and skills, the PPC Psychology Working Group sought to develop core competencies for psychologists in this subspecialty. METHODS A Working Group of pediatric psychologists with expertise in PPC met monthly to review literature and existing competencies in pediatrics, pediatric and subspecialty psychology, adult palliative care, and PPC subspecialties. Using the modified competency cube framework, the Working Group drafted core competencies for PPC psychologists. Interdisciplinary review was conducted by a diverse group of PPC professionals and parent advocates, and competencies were revised accordingly. RESULTS The six competency clusters include Science, Application, Education, Interpersonal, Professionalism, and Systems. Each cluster includes essential competencies (i.e., knowledge, skills, attitudes, roles) and behavioral anchors (i.e., examples of concrete application). Reviewer feedback highlighted clarity and thoroughness of competencies and suggested additional consideration of siblings and caregivers, spirituality, and psychologists' own positionality. CONCLUSIONS Newly developed competencies for PPC psychologists highlight unique contributions to PPC patient care and research and provide a framework for highlighting psychology's value in this emerging subspecialty. Competencies help to advocate for inclusion of psychologists as routine members of PPC teams, standardize best practices among the PPC workforce, and provide optimal care for youth with serious illness and their families.
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Affiliation(s)
| | - Megan R Schaefer
- Department of Pediatric Psychology, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Clinical Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Sarah R McCarthy
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Aimee K Hildenbrand
- Center for Healthcare Delivery Science, Nemours Children's Health, Wilmington, DE, USA
- Division of Behavioral Health, Nemours Children's Hospital, Wilmington, DE, USA
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Melissa K Cousino
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Meghan L Marsac
- Department of Pediatrics, University of Kentucky Healthcare, Lexington, KY, USA
| | - Jill Majeski
- Department of Pediatrics, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Karen Wohlheiter
- Division of Behavioral Health, Nemours Children's Hospital, Wilmington, DE, USA
| | - Rachel A Kentor
- Department of Pediatric Psychology, Texas Children's Hospital, Houston, TX, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
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Bishop C, Jackson L, Brown A. Primary palliative care skills in caring for surgical patients in the neonatal intensive care unit. Semin Pediatr Surg 2022; 31:151201. [PMID: 36038212 DOI: 10.1016/j.sempedsurg.2022.151201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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3
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Ekberg K, Ekberg S, Weinglass L, Herbert A, Rendle‐Short J, Bluebond‐Langner M, Yates P, Bradford N, Danby S. Attending to child agency in paediatric palliative care consultations: Adults' use of tag questions directed to the child. SOCIOLOGY OF HEALTH & ILLNESS 2022; 44:566-585. [PMID: 35089602 PMCID: PMC9304193 DOI: 10.1111/1467-9566.13437] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 12/02/2021] [Accepted: 01/07/2022] [Indexed: 06/18/2023]
Abstract
Children's agency in their own lives is increasingly recognised as important, including within paediatric health care. The issue of acknowledging child agency is complex in the context of paediatric palliative care, where children have serious and complex conditions that often impact their ability to verbally communicate with others. This study explores how clinicians and parents/guardians direct talk towards a child patient when they are present in a consultation. Conversation analysis methods were used to examine 74 video-recorded paediatric palliative care consultations. Detailed turn-by-turn examination of the recorded consultations identified the recurrent use of a practice described by linguists as a 'tag question', which follows some statement (e.g. 'he loves that, don't ya'). Both clinicians and parents/guardians often directed these tag questions towards the child patient. Analysis demonstrated how these tag questions: (1) validated the child's epistemic authority over what was being said and (2) made a child's response a possible, but not necessary, next action. The findings are discussed in relation to the sociology of child agency and how this agency is acknowledged and displayed within and through social interaction. This research provides direct evidence of children's competence as informants about their own symptoms.
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Affiliation(s)
- Katie Ekberg
- School of Early Childhood and Inclusive EducationQueensland University of TechnologyBrisbane CityQueenslandAustralia
| | - Stuart Ekberg
- School of Psychology & CounsellingQueensland University of TechnologyBrisbane CityQueenslandAustralia
- Centre for Healthcare TransformationQueensland University of TechnologyBrisbane CityQueenslandAustralia
| | - Lara Weinglass
- School of Early Childhood and Inclusive EducationQueensland University of TechnologyBrisbane CityQueenslandAustralia
| | - Anthony Herbert
- Children’s Health Queensland Hospital and Health ServiceBrisbane CityQueenslandAustralia
- Centre for Children's Health ResearchBrisbane CityQueenslandAustralia
- School of NursingQueensland University of TechnologyBrisbane CityQueenslandAustralia
| | - Johanna Rendle‐Short
- College of Arts and Social SciencesAustralian National UniversityCanberraAustralian Capital TerritoryAustralia
| | - Myra Bluebond‐Langner
- Louis Dundas Centre for Children’s Palliative CareUniversity College London Great Ormond Street Institute of Child HealthLondonUK
- Department of Sociology, Anthropology and Criminal JusticeRutgers UniversityCamdenNew JerseyUSA
| | - Patsy Yates
- Centre for Healthcare TransformationQueensland University of TechnologyBrisbane CityQueenslandAustralia
- Faculty of HealthQueensland University of TechnologyBrisbane CityQueenslandAustralia
| | - Natalie Bradford
- School of NursingQueensland University of TechnologyBrisbane CityQueenslandAustralia
| | - Susan Danby
- School of Early Childhood and Inclusive EducationQueensland University of TechnologyBrisbane CityQueenslandAustralia
- Australian Research Council Centre of Excellence for the Digital ChildQueensland University of TechnologyBrisbane CityQueenslandAustralia
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Feudtner C, Faerber JA, Rosenberg AR, Kobler K, Baker JN, Bowman BA, Wolfe J, Friebert S. Prioritization of Pediatric Palliative Care Field-Advancement Activities in the United States: Results of a National Survey. J Pain Symptom Manage 2021; 62:593-598. [PMID: 33485936 DOI: 10.1016/j.jpainsymman.2021.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND The field of pediatric palliative care (PPC) continues to encounter challenges and opportunities to improving access to high-quality PPC services. In early 2019, a workshop identified 11 potential "next step" actions, and subsequently a national survey-based poll of members of the PPC community was conducted to prioritize these potential actions in terms of their "actionable importance." METHODS Invitations to the survey were distributed in October 2019 to interdisciplinary PPC health care professionals via email to two major listservs, one hosted by the Section of Hospice and Palliative Medicine of the American Academy of Pediatrics, the other by the Center to Advance Palliative Care. Respondents rated the "actionable importance" of items relative to each other via a discrete choice experiment. Median importance scores are reported for each item. RESULTS One hundred seventy-seven individuals responded to the survey. The majority (62.2%) were physicians, with nurses (16.4%), advanced practice nurses (7.9%), and social workers (7.3%) being the other most common responders. The top five potential actions, in descending rank order, were: Determine what parents value regarding PPC (median score of 17.8, out of a total score of all items of 100); Define and disseminate core primary PPC curriculum (median, 15.3); Develop PPC national representation strategy and tactics (median, 12.3); Create PPC-specific program development toolkit (median, 10.9); and, Analyze payment and financing ratios (median, 9.6). CONCLUSIONS Those seeking to advance the field of PPC should take into account the findings from this study, which suggest that certain actions are more likely to have a beneficial impact on moving the field forward.
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Affiliation(s)
- Chris Feudtner
- Pediatric Advanced Care Team, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, Medical Ethics and Health Policy, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Jennifer A Faerber
- Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Abby R Rosenberg
- Palliative Care and Resilience Lab, Seattle Children's Research Institute, Seattle, WA, USA; Department of Pediatrics, University of WA School of Medicine, Seattle, WA, USA
| | - Kathie Kobler
- Center for Fetal Care, Advocate Children's Hospital, Park Ridge, IL, USA
| | - Justin N Baker
- Quality of Life for All Team; Division of Quality of Life and Palliative Care; St Jude Children's Research Hospital, Memphis, TN, USA
| | - Brynn A Bowman
- Brookdale Department of Geriatrics and Palliative Medicine, Center to Advance Palliative Care, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Sarah Friebert
- Division of Pediatric Palliative Care and Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, OH, USA; Department of Pediatrics, Northeast Ohio Medical University, Rootstown, OH, USA
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5
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Morrison LJ, Periyakoil VS, Arnold RM, Tucker R, Chittenden E, Sanchez-Reilly S, Carey EC. Launching the Next Steps to Improve Hospice and Palliative Medicine Fellow Performance Assessment: A Look Back to the Initial Toolkit of Assessment Methods. J Pain Symptom Manage 2021; 61:613-627. [PMID: 33091584 PMCID: PMC7569474 DOI: 10.1016/j.jpainsymman.2020.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 11/24/2022]
Abstract
Education leaders in hospice and palliative medicine (HPM) have long acknowledged the challenge of fellow performance assessment and the need for HPM-specific fellow assessment tools. In 2010, and in alignment with the Accreditation Council for Graduate Medical Education's (ACGME's) directive toward competency-based medical education, the national HPM Competencies Workgroup curated a set of assessment tools, the HPM Toolkit of Assessment Methods. The Toolkit has been a resource for HPM fellowship directors in evolving practical, multifaceted fellow assessment strategies. Now, as American Academy of Hospice and Palliative Medicine plans for a national workgroup in 2020 to define current HPM fellow assessment methods and to propose strategies to strengthen and standardize future assessment, the Toolkit provides a strong base from which to launch. However, the field learned important lessons from the 2010 Workgroup about the consensus process, gaps in areas of assessment, opportunities to address gaps with new or adapted tools, and limitations in implementing the Toolkit over time in terms of tracking, accessibility, and dissemination. This article describes the development of the Toolkit, including recommended tools and methods for assessment within each ACGME competency domain, and links the lessons learned to recommendations for the 2020 workgroup to consider in creating the next HPM assessment strategy and toolkit. Effective implementation will be crucial in supporting fellows to reach independent practice, which will further strengthen the field and workforce to provide the highest quality patient and family-centered care in serious illness. This will require an inspired, committed effort from the HPM community, which we enthusiastically anticipate.
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Affiliation(s)
- Laura J Morrison
- Yale Palliative Care Program, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
| | | | - Robert M Arnold
- Section of Palliative Care and Medical Ethics, University of Pittsburgh Medical School, Pittsburgh, Pennsylvania, USA
| | - Rodney Tucker
- University of Alabama at Birmingham Center for Palliative and Supportive Care, Birmingham, Alabama, USA
| | - Eva Chittenden
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sandra Sanchez-Reilly
- Department of Medicine, University of Texas Health Science Center at San Antonio and South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Elise C Carey
- Center for Palliative Medicine, Mayo Clinic, Rochester, Minnesota, USA
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6
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Weaver MS, Rosenberg AR, Fry A, Shostrom V, Wiener L. Impact of the Coronavirus Pandemic on Pediatric Palliative Care Team Structures, Services, and Care Delivery. J Palliat Med 2020; 24:1213-1220. [PMID: 33350874 DOI: 10.1089/jpm.2020.0589] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objectives: Define the impact of the coronavirus pandemic on pediatric palliative care team structures, communication, and workflow; and describe the roles, responsibilities, and reflections of interdisciplinary team members. Methods: Cross-sectional online surveys were posted on seven professional Listservs from May 2020 to June 2020. Data were summarized descriptively and with semantic content analyses. Results: N = 207 surveys were completed by pediatric palliative program representatives from 80 cities, inclusive of physicians, nurses, child life, social workers, chaplains, and psychologists. Teams consulted on <20% of potential or presumed COVID-19 cases in their centers. Sixty percent of personnel were deemed "essential" during the pandemic. One-third of personnel remained in their usual work locale, with some shifting to support adult palliative services and others working remotely. Over 60% reported a sense of team "distance" compared with "close" team cohesion, associated with physical location of team members (p < 0.01) and frequency of team counseling, education, or support meetings (p < 0.02). All programs adopted a form of telehealth for patient care, although 41% did not receive telehealth training and 73% perceived unequal care quality with virtual care. Absence of pediatric patients' family members due to visitation policies, missing human presence and physical touch, concern for personal and colleague health, and fear of financial sustainability for programs were notable stressors. Conclusions: While the number of children diagnosed with COVID-19 receiving hands-on care from pediatric palliative care teams was reportedly low, the coronavirus pandemic vastly impacted pediatric palliative care team structure, daily services, and communication models warranting attentiveness to lessons learned and future direction.
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Affiliation(s)
- Meaghann S Weaver
- Division of Pediatric Palliative Care - Hand in Hand, Children's Hospital and Medical Center, Omaha, Nebraska, USA
| | - Abby R Rosenberg
- Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.,Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Abigail Fry
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Valerie Shostrom
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Lori Wiener
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, Maryland, USA
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7
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Batt AM, Tavares W, Williams B. The development of competency frameworks in healthcare professions: a scoping review. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2020; 25:913-987. [PMID: 31797195 DOI: 10.1007/s10459-019-09946-w] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 11/23/2019] [Indexed: 05/27/2023]
Abstract
Competency frameworks serve various roles including outlining characteristics of a competent workforce, facilitating mobility, and analysing or assessing expertise. Given these roles and their relevance in the health professions, we sought to understand the methods and strategies used in the development of existing competency frameworks. We applied the Arksey and O'Malley framework to undertake this scoping review. We searched six electronic databases (MEDLINE, CINAHL, PsycINFO, EMBASE, Scopus, and ERIC) and three grey literature sources (greylit.org, Trove and Google Scholar) using keywords related to competency frameworks. We screened studies for inclusion by title and abstract, and we included studies of any type that described the development of a competency framework in a healthcare profession. Two reviewers independently extracted data including study characteristics. Data synthesis was both quantitative and qualitative. Among 5710 citations, we selected 190 for analysis. The majority of studies were conducted in medicine and nursing professions. Literature reviews and group techniques were conducted in 116 studies each (61%), and 85 (45%) outlined some form of stakeholder deliberation. We observed a significant degree of diversity in methodological strategies, inconsistent adherence to existing guidance on the selection of methods, who was involved, and based on the variation we observed in timeframes, combination, function, application and reporting of methods and strategies, there is no apparent gold standard or standardised approach to competency framework development. We observed significant variation within the conduct and reporting of the competency framework development process. While some variation can be expected given the differences across and within professions, our results suggest there is some difficulty in determining whether methods were fit-for-purpose, and therefore in making determinations regarding the appropriateness of the development process. This uncertainty may unwillingly create and legitimise uncertain or artificial outcomes. There is a need for improved guidance in the process for developing and reporting competency frameworks.
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Affiliation(s)
- Alan M Batt
- Department of Paramedicine, Monash University, Building H, McMahons Road, Frankston, VIC, 3199, Australia.
- Fanshawe College, 1001 Fanshawe College Blvd., London, ON, N5Y 5R6, Canada.
| | - Walter Tavares
- The Wilson Centre, Department of Medicine, University of Toronto/University Health Network, 200 Elizabeth Street, 1ES‑565, Toronto, ON, M5G 2C4, Canada
- Post‑MD Education (Post‑Graduate Medical Education/Continued Professional Development), University of Toronto, Toronto, ON, Canada
| | - Brett Williams
- Department of Paramedicine, Monash University, Building H, McMahons Road, Frankston, VIC, 3199, Australia
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Barnett MD, Buckholz G, Christensen A, Hwang J, Johnston CB, Landzaat L, Lupu D, Morrison LJ, Okon T, Radwany S, Yang H, Edgar L, Gustin J. Development of Subspecialty-Specific Reporting Milestones for Hospice and Palliative Medicine Fellowship Training in the U.S. J Pain Symptom Manage 2020; 60:151-157. [PMID: 31988020 DOI: 10.1016/j.jpainsymman.2020.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 01/11/2020] [Accepted: 01/13/2020] [Indexed: 11/20/2022]
Abstract
Continuing the transition to competency-based education, Hospice and Palliative Medicine (HPM) fellowship programs began using context-free reporting milestones (RMs) for internal medicine subspecialties in 2014 but quickly recognized that they did not reflect the nuanced practice of the field. This article describes the development of 20 subspecialty-specific RMs through consensus group process and vetting by HPM educators. A workgroup of content experts used an iterative consensus building process between December 2017 and February 2019 to draft new RMs and create a supplemental guide that outlines the intent of each RM, examples of each developmental trajectory, assessment methods, and resources to guide educators. Program directors, program coordinators, and designated institutional officers were contacted directly to solicit feedback. Most respondents agreed or strongly agreed that each RM represented a realistic progression of knowledge, skills, and behaviors, and that the set of milestones adequately discriminated between meaningful levels of competency. Similarly, respondents felt that the supplemental guide was a useful resource. The result is a set of carefully developed and broadly vetted RMs that represent a progression of development for HPM physicians during one year of clinical fellowship training.
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Affiliation(s)
| | - Gary Buckholz
- University of California San Diego, La Jolla, California, USA
| | | | - Jennifer Hwang
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Lindy Landzaat
- University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Dale Lupu
- George Washington University, Washington, District of Columbia, USA
| | | | | | - Steven Radwany
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Holly Yang
- Scripps Health, San Diego, California, USA
| | - Laura Edgar
- The Accreditation Council for Graduate Medical Education, Chicago, Illinois, USA
| | - Jillian Gustin
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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9
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Miller EG, Weaver MS, Ragsdale L, Hills T, Humphrey L, Williams CSP, Morvant A, Pitts B, Waldman E, Lotstein D, Linebarger J, Feudtner C, Klick JC. Lessons Learned: Identifying Items Felt To Be Critical to Leading a Pediatric Palliative Care Program in the Current Era of Program Development. J Palliat Med 2020; 24:40-45. [PMID: 32552386 DOI: 10.1089/jpm.2020.0205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The experience of starting and growing a pediatric palliative care program (PPCP) has changed over the last 10 years as rapid increases of patient volume have amplified challenges related to staffing, funding, standards of practice, team resilience, moral injury, and burnout. These challenges have stretched new directors' leadership skills, yet, guidance in the literature on identifying and managing these challenges is limited. Methods: A convenience sample of 15 PPCP directors who assumed their duties within the last 10 years were first asked the following open-ended question: What do you wish you had known before starting or taking over leadership of a PPCP? Responses were grouped into themes based on similarity of content. Participants then ranked these themes based on importance, and an online discussion further elucidated the top ten themes. Results: Thirteen directors responded (86.7%; 69% female). The median age of their current-state PPCP was 5.1 years (range: 0.3-9.3), and the median number of covered pediatric-specific hospital beds was 283 (range: 170-630). Their responses generated 51 distinct items, grouped into 17 themes. Themes ranked as most important included "Learn how to manage, not just lead," "Negotiate everything before you sign anything," and "Balance patient volume with scope of practice." Conclusion: These themes regarding challenges and opportunities PPCP directors encountered in the current era of program growth can be used as a guide for program development, a self-assessment tool for program directors, a needs-assessment for program leadership, and a blueprint for educational offerings for PPCP directors.
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Affiliation(s)
- Elissa G Miller
- Division of Palliative Medicine, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Meaghann S Weaver
- Division of Pediatric Palliative Care, Children's Hospital and Medical Center, Omaha, Nebraska, USA
| | - Lindsay Ragsdale
- Division of Pediatric Palliative Care, Department of Pediatrics, Kentucky Children's Hospital, University of Kentucky, Lexington, Kentucky, USA
| | - Tracy Hills
- Section of Pediatric Palliative Care, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lisa Humphrey
- Division of Palliative Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Conrad S P Williams
- Palliative Care Program, Department of Pediatrics, Medical University of South Carolina Children's Health System, Charleston, South Carolina, USA
| | - Alexis Morvant
- Pediatric Palliative Care Program at Children's Hospital New Orleans, Division of Ambulatory Medicine, Department of Pediatrics, Louisiana State University Health Sciences Center School of Medicine, New Orleans, Louisiana, USA
| | - Blaine Pitts
- Division of Palliative Medicine, Department of Pediatrics, Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | - Elisha Waldman
- Division of Palliative Care, Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Debra Lotstein
- Division of Comfort and Palliative Care, Department of Anesthesia Critical Care Medicine, Children's Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jennifer Linebarger
- Section of Palliative Care, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Chris Feudtner
- Pediatric Advanced Care Team, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Medical Ethics and Health Policy, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jeffrey C Klick
- Department of Palliative Care, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Division of Palliative Care, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
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10
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Gustin JL, Yang HB, Radwany SM, Okon TR, Morrison LJ, Levine SK, Hwang JM, Buckholz GT, Barnett MD, Verbeck N, Landzaat LH. Development of Curricular Milestones for Hospice and Palliative Medicine Fellowship Training in the U.S. J Pain Symptom Manage 2019; 57:1009-1017.e6. [PMID: 30790721 DOI: 10.1016/j.jpainsymman.2019.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 01/31/2019] [Accepted: 02/13/2019] [Indexed: 10/27/2022]
Abstract
CONTEXT A physician workgroup of the American Academy of Hospice and Palliative Medicine sought to define curricular milestones (CMs) for hospice and palliative medicine (HPM) Fellowship Programs. The developed list of CMs would serve as components upon which to organize curriculum and standardize what to teach during training. These would complement entrustable professional activities previously developed by this group and new specialty-specific reporting milestones (RMs) for HPM developed through the Accreditation Council for Graduate Medical Education. OBJECTIVES The objective of this study was to develop and vet CMs for HPM fellowships in the U.S. METHODS A draft of CMs was developed through an iterative consensus group process with repeated cycles of drafting, analyzing, and revising by a broadly representative expert workgroup who then gained input from HPM educators at a national meeting workshop. The CM draft was subsequently revised and then vetted through a national survey to 203 fellowship educators. Respondents were asked to "keep," "revise," or "exclude" each proposed CM with space for comments. An agreement of 75% among respondents was set as the criteria a priori for keeping a CM. Eighty-four of the 203 potential respondents participated in the survey. All items met the minimum agreement level of 75% or greater recommending keeping the CM. Greater than 85% of the respondents agreed to keep 19 of the 22 CMs with no revisions. Comments for revisions on other CMs were primarily related to changes in language and formatting, not conceptual underpinnings. CONCLUSION A group consensus method strengthened by inclusion of a national survey to HPM fellowship educators resulted in a CM document that is both carefully developed and broadly vetted. Along with entrustable professional activities and new specialty-specific RMs, these CMs offer educators and trainees tools to create more comprehensive curricula and behaviorally based assessment tools for HPM fellowships and their stakeholders.
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Affiliation(s)
- Jillian L Gustin
- Division of Palliative Medicine, Department of Internal Medicine, Hospice and Palliative Medicine Fellowship Program, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
| | - Holly B Yang
- University of California San Diego/Scripps Health Hospice and Palliative Medicine Fellowship Program, Scripps Health, San Diego, California, USA
| | - Steven M Radwany
- Division of Palliative Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Tomasz R Okon
- Marshfield Clinic Palliative Medicine Fellowship, Marshfield Clinic, Marshfield, Wisconsin, USA
| | - Laura J Morrison
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Stacie K Levine
- Palliative Medicine Programs, University of Chicago, Chicago, Illinois, USA
| | - Jennifer M Hwang
- Pediatric Advanced Care Team and Hospice and Palliative Medicine Fellowship, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Clinical Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gary T Buckholz
- University of California San Diego/Scripps Health Hospice and Palliative Medicine Fellowship, University of California San Diego, La Jolla, California, USA
| | | | - Nicole Verbeck
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Lindy H Landzaat
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
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11
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Implementation of a Competency-Based, Interdisciplinary Pediatric Palliative Care Curriculum Using Content and Format Preferred by Pediatric Residents. CHILDREN-BASEL 2018; 5:children5120156. [PMID: 30469517 PMCID: PMC6306952 DOI: 10.3390/children5120156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 11/15/2018] [Accepted: 11/19/2018] [Indexed: 11/16/2022]
Abstract
Palliative care competencies at the pediatric resident training level expand learned knowledge into behavior. The objective of this study was to investigate mode of palliative care education delivery preferred by pediatric residents and to report on participatory approach to resident palliative care curriculum design. A one-hour monthly palliative care curriculum was designed and implemented in a participatory manner with 20 pediatric residents at a free-standing Midwestern children’s hospital. Outcome measures included pediatric residents’ personal attitude and perceived training environment receptivity before and after implementation of a palliative care competency-based curriculum. An 18-item survey utilizing Social Cognitive Theory Constructs was administered at baseline and after palliative care curriculum implementation (2017–2018 curricular year). Pediatric residents prioritized real case discussions in group format (16/20) over other learning formats. Topics of highest interest at baseline were: discussing prognosis and delivering bad news (weighted average 12.9), pain control (12.3), goals of care to include code status (11.1), and integrative therapies (10.7). Summary of ordinal responses revealed improvement in self-assessment of personal attitude toward palliative care and training environment receptivity to palliative care domains after year-long curriculum implementation. Curricular approach which is attentive to pediatric residents’ preferred learning format and self-assessment of their behaviors within their care setting environment may be beneficial in competency-based primary palliative training.
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12
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Geerse OP, Lakin JR, Berendsen AJ, Alfano CM, Nekhlyudov L. Cancer survivorship and palliative care: Shared progress, challenges, and opportunities. Cancer 2018; 124:4435-4441. [DOI: 10.1002/cncr.31723] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Olaf P. Geerse
- Department of Pulmonary Diseases University Medical Center Groningen, University of Groningen Groningen the Netherlands
- Ariadne Labs Brigham and Women’s Hospital, Harvard T. H. Chan School of Public Health Boston Massachusetts
| | - Joshua R. Lakin
- Ariadne Labs Brigham and Women’s Hospital, Harvard T. H. Chan School of Public Health Boston Massachusetts
- Department of Medicine Brigham and Women’s Hospital Boston Massachusetts
- Department of Psychosocial Oncology and Palliative Care Dana‐Farber Cancer Institute Boston Massachusetts
| | - Annette J. Berendsen
- Department of General Practice and Elderly Medicine University Medical Center Groningen, University of Groningen Groningen the Netherlands
| | | | - Larissa Nekhlyudov
- Department of Medicine Brigham and Women’s Hospital Boston Massachusetts
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13
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Ekberg S, Bradford NK, Herbert A, Danby S, Yates P. Healthcare Users' Experiences of Communicating with Healthcare Professionals About Children Who Have Life-Limiting Conditions: A Qualitative Systematic Review. J Palliat Med 2018; 21:1518-1528. [PMID: 29762072 DOI: 10.1089/jpm.2017.0422] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Globally, an estimated eight million children could benefit from palliative care each year. Effective communication about children with life-limiting conditions is well recognized as a critical component of high-quality pediatric palliative care. OBJECTIVE To synthesize existing qualitative research exploring healthcare users' experiences of communicating with healthcare professionals about children with life-limiting conditions. DESIGN The results of a systematic literature search were screened independently by two reviewers. Raw data and analytic claims were extracted from included studies and were synthesized using thematic analysis methods for systematic reviews. DATA SOURCES MEDLINE, PubMed, CINAHL, Embase, PsycINFO, Scopus, Web of Science, ProQuest, and ScienceDirect were searched for articles published in English between 1990 and May 2017. RESULTS This review included 29 studies conducted across 11 countries and involving at least 979 healthcare users (adults [n = 914], patients [n = 25], and siblings [n = 40]). The four domains of communication experience identified through thematic synthesis are: Information, Emotion, Collaboration, and Relationship. Although included studies were from a range of settings and diverse populations, further research is needed to explore whether and how domains of communication experience differ across settings and populations. In particular, further research about children's palliative care experiences is needed. CONCLUSIONS Healthcare users typically value communication with healthcare professionals: that (1) is open and honest, (2) acknowledges emotion, (3) actively involves healthcare users, and (4) occurs within established and trusting relationships.
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Affiliation(s)
- Stuart Ekberg
- 1 Institute of Health and Biomedical Innovation , Queensland University of Technology, Brisbane, Queensland, Australia .,2 School of Psychology and Counselling, Queensland University of Technology , Queensland, Australia, Brisbane, Queensland, Australia
| | - Natalie K Bradford
- 3 Children's Health Queensland Hospital and Health Service , Brisbane, Queensland, Australia
| | - Anthony Herbert
- 3 Children's Health Queensland Hospital and Health Service , Brisbane, Queensland, Australia .,4 Children's Health Queensland Clinical Unit, Faculty of Medicine, University of Queensland , Brisbane, Queensland, Australia
| | - Susan Danby
- 5 School of Early Childhood and Inclusive Education , Queensland University of Technology, Brisbane, Queensland, Australia
| | - Patsy Yates
- 1 Institute of Health and Biomedical Innovation , Queensland University of Technology, Brisbane, Queensland, Australia .,6 School of Nursing, Queensland University of Technology , Brisbane, Queensland, Australia
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14
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Shoenberger J, Lamba S, Goett R, DeSandre P, Aberger K, Bigelow S, Brandtman T, Chan GK, Zalenski R, Wang D, Rosenberg M, Jubanyik K. Development of Hospice and Palliative Medicine Knowledge and Skills for Emergency Medicine Residents: Using the Accreditation Council for Graduate Medical Education Milestone Framework. AEM EDUCATION AND TRAINING 2018; 2:130-145. [PMID: 30051080 PMCID: PMC6001832 DOI: 10.1002/aet2.10088] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/25/2018] [Accepted: 01/28/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Emergency medicine (EM) physicians commonly care for patients with serious life-limiting illness. Hospice and palliative medicine (HPM) is a subspecialty pathway of EM. Although a subspecialty level of practice requires additional training, primary-level skills of HPM such as effective communication and symptom management are part of routine clinical care and expected of EM residents. However, unlike EM residency curricula in disciplines like trauma and ultrasound, there is no nationally defined HPM curriculum for EM resident training. An expert consensus group was convened with the aim of defining content areas and competencies for HPM primary-level practice in the ED setting. Our overall objective was to develop HPM milestones within a competency framework that is relevant to the practice of EM. METHODS The American College of Emergency Physicians Palliative Medicine Section assembled a committee that included academic EM faculty, community EM physicians, EM residents, and nurses, all with interest and expertise in curricular design and palliative medicine. RESULTS The committee peer reviewed and assessed HPM content for validity and importance to EM residency training. A topic list was developed with three domains: provider skill set, clinical recognition of HPM needs, and logistic understanding related to HPM in the ED. The group also developed milestones in HPM-EM to identify relevant knowledge, skills, and behaviors using the framework modeled after the Accreditation Council for Graduate Medical Education (ACGME) EM milestones. This framework was chosen to make the product as user-friendly and familiar as possible to facilitate use by EM educators. CONCLUSIONS Educators in EM residency programs now have access to HPM content areas and milestones relevant to EM practice that can be used for curriculum development in EM residency programs. The HPM-EM skills/competencies presented herein are structured in a familiar milestone framework that is modeled after the widely accepted ACGME EM milestones.
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Affiliation(s)
- Jan Shoenberger
- Keck School of Medicine of the University of Southern CaliforniaLos AngelesCA
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15
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Rossfeld ZM, Tumin D, Humphrey LM. Self-Assessment of Skills and Competencies among Residents Participating in a Pediatric Hospice and Palliative Medicine Elective Rotation. J Palliat Med 2018; 21:229-235. [DOI: 10.1089/jpm.2017.0201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Zachary M. Rossfeld
- Section of Hospice and Palliative Care, Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Dmitry Tumin
- Section of Hospice and Palliative Care, Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Lisa M. Humphrey
- Section of Hospice and Palliative Care, Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio
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16
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Assessing Palliative and End-of-Life Educational Needs of Pediatric Health Care Professionals. J Hosp Palliat Nurs 2017. [DOI: 10.1097/njh.0000000000000374] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Landzaat LH, Barnett MD, Buckholz GT, Gustin JL, Hwang JM, Levine SK, Okon TR, Radwany SM, Yang HB, Encandela J, Morrison LJ. Development of Entrustable Professional Activities for Hospice and Palliative Medicine Fellowship Training in the United States. J Pain Symptom Manage 2017; 54:609-616.e1. [PMID: 28729009 DOI: 10.1016/j.jpainsymman.2017.07.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 06/06/2017] [Accepted: 07/06/2017] [Indexed: 11/22/2022]
Abstract
CONTEXT Entrustable Professional Activities (EPAs) represent the key physician tasks of a specialty. Once a trainee demonstrates competence in an activity, they can then be "entrusted" to practice without supervision. A physician workgroup of the American Academy of Hospice and Palliative Medicine sought to define Hospice and Palliative Medicine (HPM) EPAs. OBJECTIVE The objective of this study was to describe the development of a set of consensus EPAs for HPM fellowship training in the United States. METHODS A set of HPM EPAs was developed through an iterative consensus process involving an expert workgroup, vetting at a national meeting with HPM educators, and an electronic survey from a national registry of 3550 HPM physicians. Vetting feedback was reviewed, and survey data were statistically analyzed. Final EPA revisions followed from the multisource feedback. RESULTS Through the iterative consensus process, a set of 17 HPM EPAs was created, detailed, and revised. In the national survey, 362 HPM specialists responded (10%), including 58 of 126 fellowship program directors (46%). Respondents indicated that the set of 17 EPAs well represented the core activities of HPM physician practice (mean 4.72 on a five-point Likert scale) and considered all EPAs to either be "essential" or "important" with none of the EPAs ranking "neither essential, nor important." CONCLUSIONS A set of 17 EPAs was developed using national input of practicing physicians and program directors and an iterative expert workgroup consensus process. The workgroup anticipates that EPAs can assist fellowship directors with strengthening competency-based training curricula.
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Affiliation(s)
- Lindy H Landzaat
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA.
| | | | - Gary T Buckholz
- University of California San Diego/Scripps Health Hospice and Palliative Medicine Fellowship, University of California San Diego, La Jolla, California, USA
| | - Jillian L Gustin
- Division of Palliative Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jennifer M Hwang
- The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | - Steven M Radwany
- Summa Health and Northeast Ohio Medical University, Akron, Ohio, USA
| | - Holly B Yang
- University of California San Diego/Scripps Health, Scripps Health San Diego, California, USA
| | - John Encandela
- Teaching and Learning Center Yale School of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Laura J Morrison
- Yale Palliative Care Program, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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18
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Eckstrand KL, Potter J, Bayer CR, Englander R. Giving Context to the Physician Competency Reference Set: Adapting to the Needs of Diverse Populations. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2016; 91:930-5. [PMID: 26796092 PMCID: PMC4925271 DOI: 10.1097/acm.0000000000001088] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Delineating the requisite competencies of a 21st-century physician is the first step in the paradigm shift to competency-based medical education. Over the past two decades, more than 150 lists of competencies have emerged. In a synthesis of these lists, the Physician Competency Reference Set (PCRS) provided a unifying framework of competencies that define the general physician. The PCRS is not context or population specific; however, competently caring for certain underrepresented populations or specific medical conditions can require more specific context. Previously developed competency lists describing care for these populations have been disconnected from an overarching competency framework, limiting their uptake. To address this gap, the Association of American Medical Colleges Advisory Committee on Sexual Orientation, Gender Identity, and Sex Development adapted the PCRS by adding context- and content-specific qualifying statements to existing PCRS competencies to better meet the needs of diverse patient populations. This Article describes the committee's process in developing these qualifiers of competence. To facilitate widespread adoption of the contextualized competencies in U.S. medical schools, the committee used an established competency framework to develop qualifiers of competence to improve the health of individuals who are lesbian, gay, bisexual, transgender; gender nonconforming; or born with differences in sexual development. This process can be applied to other underrepresented populations or medical conditions, ensuring that relevant topics are included in medical education and, ultimately, health care outcomes are improved for all patients inclusive of diversity, background, and ability.
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Affiliation(s)
- Kristen L Eckstrand
- K.L. Eckstrand is a psychiatry resident, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, and founding chair, Association of American Medical Colleges, Advisory Committee on Sexual Orientation, Gender Identity, and Sex Development, Washington, DC. J. Potter is associate professor of medicine, Harvard Medical School, Cambridge, Massachusetts, and director, Women's Health Research, Fenway Institute, Boston, Massachusetts. C.R. Bayer is associate professor, Morehouse School of Medicine, and associate director of educational leadership, Satcher Health Leadership Institute, Morehouse School of Medicine, Atlanta, Georgia. R. Englander was senior director of competency-based learning and assessment, Association of American Medical Colleges, and is currently adjunct professor of pediatrics, George Washington School of Medicine, Washington, DC
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19
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Liberman DB, Song E, Radbill LM, Pham PK, Derrington SF. Early introduction of palliative care and advanced care planning for children with complex chronic medical conditions: a pilot study. Child Care Health Dev 2016; 42:439-49. [PMID: 27028099 DOI: 10.1111/cch.12332] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 01/25/2016] [Accepted: 02/04/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Children with complex chronic medical conditions benefit from early introduction of palliative care services and advanced care planning for symptom management and to support quality of life and medical decision-making. This study evaluated whether introducing palliative care during primary care appointments (1) was feasible; (2) increased access and improved knowledge of palliative care; and (3) facilitated advanced care planning. METHODS Pilot study of a multi-modal intervention including targeted education for primary care providers (PCPs), an informational packet for families and presence of a palliative care team member in the outpatient clinic. PCPs completed pre- and post-surveys assessing experience, knowledge and comfort with palliative care. Enrolled families received an information packet; a subset also met a palliative care team member. All families were encouraged to make an appointment with the palliative care team, during which the team assessed palliative care needs and goals of care. Upon study completion, the investigators assessed family and PCP satisfaction and collected feedback on project feasibility. RESULTS Twenty families were enrolled and received the information packet; 15 met a palliative care team member. Of the 17 participating families who were reached and completed a post-study survey, 11 families had never heard of palliative care and 13 were unaware that the palliative care team existed. Most families perceived palliative care information as 'very helpful' and 'very important'. All would recommend palliative care team services to others. Nine families followed up with the palliative care team, but none was prepared to complete an advanced care plan. PCPs reported lack of training in communicating bad news and conducting goals of care discussions. However, they felt increasingly comfortable introducing palliative care to families and supported program continuation. CONCLUSIONS Initiating palliative care services in the outpatient primary care setting is logistically challenging but increases access to palliative care for children with complex chronic medical conditions and improves palliative care knowledge and comfort for PCPs.
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Affiliation(s)
- D B Liberman
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - E Song
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - L M Radbill
- Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.,Division of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - P K Pham
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - S F Derrington
- Division of Critical Care and Program in Palliative Care, Ann and Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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20
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Quinn C, Hillis R. Findings from a Clinical Learning Needs Survey at Ireland's first children's hospice. Int J Palliat Nurs 2015; 21:596-601. [PMID: 26707488 DOI: 10.12968/ijpn.2015.21.12.596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE Caring for children with life-limiting conditions places exceptional demands on health professionals. Staff require the optimal skills and expertise necessary to provide the highest quality of care and to achieve this it is essential to understand their learning requirements. AIM The aim is to share the main findings from a Clinical Learning Needs Survey conducted at LauraLynn, currently Ireland's only children's hospice. To date no other Irish service has conducted a formal identification of professional learning and development needs specific to the Irish context. The findings from the study assist workforce planning by providing a glimpse into the immediate study needs of staff working in a children's palliative care setting. The study had two main aims: a) Assist clinical staff within one organisation to identify their own professional learning priorities in children's palliative care and b) Inform the design and delivery of a responsive suite of workshops, programmes and study sessions for children's palliative care. RESULTS The study identified the key learning needs as end-of-life care, palliative emergencies, communication skill development and bereavement support. CONCLUSION These findings are similar to those found internationally and demonstrate the commitment of a new organisation to ensure that specific employee learning requirements are met if the organisation and wider specialty of Irish children's palliative care is to continue its evolution.
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Affiliation(s)
- Claire Quinn
- Head of Research, LauraLynn, Children's Hospice, Dublin Ireland/Honorary Lecturer, National University of Ireland, Galway
| | - Rowan Hillis
- Research and Data Officer, Laura Lynn, Ireland's Children's Hospice, Dublin, Ireland
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21
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Baker JN, Levine DR, Hinds PS, Weaver MS, Cunningham MJ, Johnson L, Anghelescu D, Mandrell B, Gibson DV, Jones B, Wolfe J, Feudtner C, Friebert S, Carter B, Kane JR. Research Priorities in Pediatric Palliative Care. J Pediatr 2015; 167:467-70.e3. [PMID: 26028284 PMCID: PMC4516589 DOI: 10.1016/j.jpeds.2015.05.002] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 04/20/2015] [Accepted: 05/01/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To synthesize the perspectives of a broad range of pediatric palliative care (PPC) clinicians and parents, to formulate a consensus on prioritization of the PPC research agenda. STUDY DESIGN A 4-round modified Delphi online survey was administered to PPC experts and to parents of children who had received PPC. In round 1, research priorities were generated spontaneously. Rounds 2 and 3 then served as convergence rounds to synthesize priorities. In round 4, participants were asked to rank the research priorities that had reached at least 80% consensus. RESULTS A total of 3093 concepts were spontaneously generated by 170 experts and 72 parents in round 1 (65.8% response rate [RR]). These concepts were thematically organized into 78 priorities and recirculated for round 2 ratings (n = 130; 53.7% RR). Round 3 achieved response stability, with 31 consensus priorities oscillating within 10% of the mode (n = 98; 75.4% RR). Round 4 resulted in consensus recognition of 20 research priorities, which were thematically grouped as decision making, care coordination, symptom management, quality improvement, and education. CONCLUSIONS This modified Delphi survey used professional and parental consensus to identify preeminent PPC research priorities. Attentiveness to these priorities may help direct resources and efforts toward building a formative evidence base. Investigating PPC implementation approaches and outcomes can help improve the quality of care services for children and families.
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Affiliation(s)
- Justin N Baker
- Department of Oncology and Division of Quality of Life and Palliative Care, St Jude Children's Research Hospital, Memphis, TN.
| | - Deena R Levine
- Department of Oncology and Division of Quality of Life and Palliative Care, St Jude Children's Research Hospital, Memphis, TN
| | - Pamela S Hinds
- Department of Nursing Research and Quality Outcomes, Center for Translational Research, Children's National Health System, Washington, DC
| | - Meaghann S Weaver
- Department of Oncology and Division of Quality of Life and Palliative Care, St Jude Children's Research Hospital, Memphis, TN
| | - Melody J Cunningham
- Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, TN
| | - Liza Johnson
- Department of Oncology and Division of Quality of Life and Palliative Care, St Jude Children's Research Hospital, Memphis, TN
| | - Doralina Anghelescu
- Department of Oncology and Division of Quality of Life and Palliative Care, St Jude Children's Research Hospital, Memphis, TN
| | - Belinda Mandrell
- Division of Nursing Research, Department of Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Deborah V Gibson
- Department of Oncology and Division of Quality of Life and Palliative Care, St Jude Children's Research Hospital, Memphis, TN
| | - Barbara Jones
- School of Social Work, University of Texas, Austin, TX
| | - Joanne Wolfe
- Division of Pediatric Palliative Care, Department of Psychosocial and Palliative Care, Dana-Farber Cancer Institute, and Department of Medicine, Boston Children's Hospital, Boston, MA
| | - Chris Feudtner
- Division of Pediatric Palliative Care, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Sarah Friebert
- Haslinger Division of Pediatric Palliative Care, Akron Children's Hospital, Akron, OH
| | - Brian Carter
- Departments of Neonatology and Bioethics, Mercy Hospital Center and Clinics, Kansas City, KS
| | - Javier R Kane
- Department of Pediatrics, McLane Children's Hospital and Clinics, Baylor Scott & White Health, and Texas A&M Health Science Center College of Medicine, Temple, TX
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