Palliative education: a didactic and experiential approach to teaching end-of-life care

BACKGROUND

The training in palliative care that health professionals receive is inadequate. An aging population, changing systems of health care delivery, and the debate about euthanasia and physician-assisted suicide increase the importance of ongoing education about palliative care.

METHODS

Three modules are offered by the University of California, Davis, West Coast Center for Palliative Education (WCCPE). Module 1, offered on-site, blends didactic and field learning using lectures, case studies, patient contact, and role modeling. Module 2 programs, held off-site, are customized in collaboration with the sponsor to address local needs and concerns. This module emphasizes group discussion and problem solving. Module 3 trains health care and custody staff and volunteer inmates at correctional facilities. Inmate training focuses on developing communication skills and a capacity to empathize through experiential exercises, dialog, and role-playing.

RESULTS

Off-site training significantly improved self-assessed knowledge about pain management and attitudes towards end-of-life care. Qualitative measures showed enhanced care-delivery skills for participants in all three modules.

CONCLUSIONS

Palliative care education can be enhanced when delivered close to the point of care using multimodal techniques that influence attitudes as well as knowledge.

Effects of changing skill mix

Although many facilities believe turning over some patient care to unlicensed caregivers will cut costs, results show otherwise. The greater the rate of change--patient acuity--the greater the need for an all-RN staff. Skill mix, length of stay and salary costs among five teaching hospitals measure the cost effects.