Palliative Care Core Competencies in Undergraduate Medical Education: Medical Student End-of-Life Care Training and Experience with Patient Death at Duke University (S767)

ObjectivesImpending death is poorly recognised. Many undergraduate healthcare professionals will not have experience of meeting or caring for someone who is dying. As death can occur in any setting, at any time, it is vital that all healthcare students, regardless of the setting they go on to work in, have end-of-life care (EOLC) training. The aim was to determine current palliative care training at the undergraduate level, in multiple professions, in recognising and communicating dying.MethodsCurrent UK undergraduate courses in medicine, adult nursing, occupational therapy, social work and physiotherapy were included. All courses received an email asking what training is currently offered in the recognition and communication of dying, and what time was dedicated to this.ResultsA total of 73/198 (37%) courses responded to the request for information. 18/20 medical courses provided training in recognising when patients were dying (median 2 hours), and 17/20 provided training in the communication of dying (median 3 hours). 80% (43/54) of nursing and allied health professional courses provided some training in EOLC. Many of the course organisers expressed frustration at the lack of resources, funding and time to include more training. Those courses with more palliative care provision often had a ‘champion’ to advocate for it.ConclusionsTraining in EOLC was inconsistent across courses and professions. Further research is needed to understand how to remove the barriers identified and to improve the consistency of current training.

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Do residents need end-of-life care training?

Palliative & Supportive Care ◽

10.1017/s1478951512001101 ◽

2013 ◽

Vol 12 (3) ◽

pp. 195-201 ◽

Cited By ~ 13

Author(s):

Agata Marszalek Litauska ◽

Andrzej Kozikowski ◽

Christian N. Nouryan ◽

Myriam Kline ◽

Renee Pekmezaris ◽

...

Keyword(s):

Medical Education ◽

End Of Life ◽

End Of Life Care ◽

Hospice Care ◽

Comfort Level ◽

Professional Status ◽

Life Care ◽

Hospice Referral ◽

Care Training ◽

The Right

AbstractObjective:As medical education evolves, emphasis on chronic care management within the medical curriculum becomes essential. Because of the consistent lack of appropriate end-of-life care training, far too many patients die without the benefits of hospice care. This study explores the association between physician knowledge, training status, and level of comfort with hospice care referral of terminally ill patients.Method:In 2011, anonymous surveys were distributed to physicians in postgraduate years 1, 2, and 3; fellows; hospital attending physicians; specialists; and other healthcare professionals in five hospitals of a large health system in New York. Demographic comparisons were performed using χ2 and Fisher's exact tests. Spearman correlations were calculated to determine if professional status and experience were associated with comfort and knowledge discussing end-of-life topics with terminal patients.Results:The sample consisted of 280 participants (46.7% response rate). Almost a quarter (22%) did not know key hospice referral criteria. Although 88% of respondents felt that knowledge of hospice care is an important competence, 53.2% still relinquished advance directives discussion to emergency room (ER) physicians. Fear of patient/family anger was the most frequently reported hospice referral barrier, although 96% of physicians rarely experienced reprisals. Physician comfort level discussing end-of-life issues and hospice referral was significantly associated with the number of years practicing medicine and professional status.Significance of results:Physicians continue to relinquish end-of-life care to ER staff and palliative care consultants. Exploring unfounded and preconceived fears associated with hospice referral needs to be integrated into the curriculum, to prepare future generations of physicians. Medical education should focus on delivering the right amount of end-of-life care training, at the right time, within the medical school and residency curriculum.

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Pain therapy, pediatric palliative care and end-of-life care: training, experience, and reactions of pediatric residents in Italy

European Journal of Pediatrics ◽

10.1007/s00431-014-2304-8 ◽

2014 ◽

Vol 173 (9) ◽

pp. 1201-1207 ◽

Cited By ~ 3

Author(s):

Francesca Rusalen ◽

Anna Ferrante ◽

Chiara Pò ◽

Michele Salata ◽

Caterina Agosto ◽

...

Keyword(s):

Palliative Care ◽

End Of Life ◽

End Of Life Care ◽

Pain Therapy ◽

Pediatric Palliative Care ◽

Life Care ◽

Training Experience ◽

Pediatric Residents ◽

Care Training

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End-of-Life Care Patterns at a Community Hospital: The Rest of the Story

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909116673300 ◽

2016 ◽

Vol 34 (10) ◽

pp. 977-983 ◽

Cited By ~ 1

Author(s):

Kip Waite ◽

Jane Rhule ◽

David Bush ◽

Barry Meisenberg

Keyword(s):

Palliative Care ◽

End Of Life ◽

End Of Life Care ◽

Community Hospital ◽

Diagnosis Related Groups ◽

Life Care ◽

Patient Death ◽

Palliative Care Consultation ◽

Short Period ◽

Care Patterns

We undertook a retrospective review of a subset of expired patients at our community hospital to evaluate end-of-life care patterns and the use of advanced care planning tools among patients who died in the hospital. These 162 expired patients fell into 1 of the 3 diagnosis-related groups of cardiac, respiratory, or infectious disease. Seventy-nine percent of patients arrived to the hospital with no requested limitations in the extent of resuscitative efforts, even though 98% of all patients had major or extreme severity of illness and risk of mortality scores. The presence of an advance directive requesting a limitation of resuscitative efforts modestly impacted resources and procedures, even though utilization in this group was high. Among the 21% of patients with preexisting limits, 21% requested more aggressive support during their course. Critical care unit utilization was seen in 69% of patients for a median of 48 hours. A request for palliative care consultation was received in 44% of patients but only occurred in 30% of all patients due to the short period between the consultation request and patient death (median 37 hours). Among this group of dying patients, engagement of the palliative care team came too late in the course of many patients, suggesting that automated tools embedded in the electronic medical record might be helpful in the identification of appropriate patients earlier.

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Opinion and Special Article: Next Steps in Palliative Care Education for Neurology Residents

Neurology ◽

10.1212/wnl.0000000000012911 ◽

2021 ◽

pp. 10.1212/WNL.0000000000012911

Author(s):

Tara Cook ◽

Robert Arnold ◽

Kwonho Jeong ◽

Julie Childers

Keyword(s):

Palliative Care ◽

End Of Life ◽

End Of Life Care ◽

Life Care ◽

End Of Life Decisions ◽

Neurologic Diseases ◽

Residency Programs ◽

Palliative Care Education ◽

Care Training

Many neurologic diseases are life limiting and markedly impair patients' quality of life. Growing recommendations in the field recommend that neurologists have primary skills in palliative medicine that will allow them to manage symptoms and discuss end of life decisions with patients and families. Previous work has shown that formal palliative care training in neurology residencies is very limited. In this paper we briefly describe a national survey of neurology residents where we assess both the quantity and quality of the teaching they receive in end-of-life care as compared to a common and an uncommon neurologic condition. Based on the gaps we identified, as well as previous studies and recommendations in neuropalliative care, we provide nine recommendations to help neurology residency programs improve their teaching of primary neuropalliative care skills.

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A Longitudinal Aging and End-of-Life Care Curriculum for Medical Students Using the Geriatric 5Ms Framework

Innovation in Aging ◽

10.1093/geroni/igaa057.029 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 9-9

Author(s):

Andrea Schwartz ◽

Kristen Schaefer

Keyword(s):

Older Adults ◽

Palliative Care ◽

Medical Student ◽

Medical Students ◽

End Of Life ◽

Curriculum Design ◽

End Of Life Care ◽

Flipped Classroom ◽

Clinical Skills ◽

Life Care

Abstract Medical student training in geriatrics and palliative care is critical to prepare them to care for older adults and those facing serious illness. We created a longitudinal Aging and End of Life Care Curriculum at Harvard Medical School, using Kern’s Curriculum Design Model. We conducted a focused needs assessment survey with course and clerkship directors, then implemented curricula based on the AAMC and Hartford Foundation’s 26 learning objectives in Geriatrics (Leipzig et al, Acad Med 2009), and “Raising the Bar for the care of seriously ill patients” which established competencies for medical students in palliative care (Schaefer at al, Acad Med 2014). We structured the curricular content to enable spaced learning, using the Geriatric 5Ms framework of Mobility, Mind, Medications, Multi-complexity and Matters Most (Tinetti at al, JAGS 2017), which aligns with the Age Friendly Health Systems Initiative priorities. Students participate in trainings on Delivering Serious News and Goals of Care Conversations, structured home visits with older adults, and clinical reasoning sessions focused on falls, delirium and polypharmacy risk reduction. The curriculum includes interactive, case based and jigsaw learning, as well as flipped classroom learning. Students are evaluated using a three part longitudinal Objective Structured Clinical Examination with an aging patient, which demonstrates an increase in medical student clinical skills in geriatrics. Individual sessions of the curriculum demonstrate increases in student knowledge of and attitude to geriatrics; longitudinal assessment is ongoing to ensure that students graduate ready to care for an aging society with competence, knowledge and compassion.

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Honoring Preferences—The Consistency Between End-of-Life Care and a Veteran’s Goal for Comfort Care

Innovation in Aging ◽

10.1093/geroni/igaa057.2711 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 752-752

Author(s):

Joan Carpenter ◽

Winifred Scott ◽

Mary Ersek ◽

Cari Levy ◽

Jennifer Cohen ◽

...

Keyword(s):

Palliative Care ◽

Logistic Regression ◽

End Of Life ◽

End Of Life Care ◽

Life Care ◽

Multivariate Logistic Regression ◽

Comfort Care ◽

Lower Odds ◽

Medicare Data ◽

Life Sustaining Treatment

Abstract This study examined the alignment between Veterans’ end-of-life care and a Life-Sustaining Treatment (LST) goal “to be comfortable.” It includes Veterans with VA inpatient or community living center stays overlapping July 2018--January 2019, with a LST template documented by January 31, 2019, and who died by April 30, 2019 (N = 18,163). Using VA and Medicare data, we found 80% of decedents with a comfort care goal received hospice and 57% a palliative care consult (compared to 57% and 46%, respectively, of decedents without a comfort care goal). Using multivariate logistic regression, a comfort care goal was associated with significantly lower odds of EOL hospital or ICU use. In the last 30 days of life, Veterans with a comfort care goal had 43% lower odds (AOR 0.57; 95% CI: 0.51, 0.64) of hospitalization and 46% lower odds of ICU use (AOR 0.54; 95% CI: 0.48, 0.61).

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Harnessing the Chaplain’s Capacity to Identify Unmet Palliative Needs of Vulnerable Older Adults in the Emergency Department

Journal of Palliative Care ◽

10.1177/08258597211003359 ◽

2021 ◽

pp. 082585972110033

Author(s):

Elizabeth Hamill Howard ◽

Rachel Schwartz ◽

Bruce Feldstein ◽

Marita Grudzen ◽

Lori Klein ◽

...

Keyword(s):

Emergency Department ◽

Palliative Care ◽

End Of Life Care ◽

Older Patients ◽

Chart Review ◽

Retrospective Chart Review ◽

Life Care ◽

Emergency Medicine Physician ◽

Medicine Physician ◽

One Year

Objective: To explore chaplains’ ability to identify unmet palliative care (PC) needs in older emergency department (ED) patients. Methods: A palliative chaplain-fellow conducted a retrospective chart review evaluating 580 ED patients, age ≥80 using the Palliative Care and Rapid Emergency Screening (P-CaRES) tool. An emergency medicine physician and chaplain-fellow screened 10% of these charts to provide a clinical assessment. One year post-study, charts were re-examined to identify which patients received PC consultation (PCC) or died, providing an objective metric for comparing predicted needs with services received. Results: Within one year of ED presentation, 31% of the patient sub-sample received PCC; 17% died. Forty percent of deceased patients did not receive PCC. Of this 40%, chaplain screening for P-CaRES eligibility correctly identified 75% of the deceased as needing PCC. Conclusion: Establishing chaplain-led PC screenings as standard practice in the ED setting may improve end-of-life care for older patients.

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Help Me Understand: Providing Palliative Care to Individuals With Serious Mental Illness

American Journal of Hospice and Palliative Medicine® ◽

10.1177/10499091211010722 ◽

2021 ◽

pp. 104990912110107

Author(s):

Kate L. M. Hinrichs ◽

Cindy B. Woolverton ◽

Jordana L. Meyerson

Keyword(s):

Mental Illness ◽

Palliative Care ◽

End Of Life ◽

Serious Mental Illness ◽

End Of Life Care ◽

Psychosocial Support ◽

Life Care ◽

Case Examples ◽

Increased Risk ◽

Palliative Care Teams

Individuals with serious mental illness (SMI) have shortened life expectancy with increased risk of developing comorbid medical illnesses. They might have difficulty accessing care and can be lost to follow-up due to complex socioeconomic factors, placing them at greater risk of dying from chronic or undiagnosed conditions. This, in combination with stigma associated with SMI, can result in lower quality end-of-life care. Interdisciplinary palliative care teams are in a unique position to lend assistance to those with SMI given their expertise in serious illness communication, values-based care, and psychosocial support. However, palliative care teams might be unfamiliar with the hallmark features of the various SMI diagnoses. Consequently, recognizing and managing exacerbations of SMI while delivering concurrent palliative or end-of-life care can feel challenging. The goal of this narrative review is to describe the benefits of providing palliative care to individuals with SMI with concrete suggestions for communication and use of recovery-oriented language in the treatment of individuals with SMI. The salient features of 3 SMI diagnoses—Bipolar Disorders, Major Depressive Disorder, and Schizophrenia—are outlined through case examples. Recommendations for working with individuals who have SMI and other life-limiting illness are provided, including strategies to effectively manage SMI exacerbations.

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