Palliative Care in Medical Education at McMaster University

1989 ◽  
Vol 5 (1) ◽  
pp. 16-20 ◽  
Author(s):  
Fred I. Burge
Keyword(s):  
Palliative Care ◽  
Medical Education ◽  
Ethical Issues ◽  
Postgraduate Medical Education ◽  
Symptom Assessment ◽  
Current Approach ◽  
Control Approach ◽  
Philosophy Of Palliative Care ◽  
Student Physician ◽  
And Control

As professionals working within palliative care struggle to find their niche in the academic, administrative and service continuum of patient care, we have a growing desire to share what has been learned with students and colleagues. The opportunities for student physicians to learn the principles and practices of caring for the dying are few. The described curriculum content is dependent on the McMaster philosophy of medical education and the developmental level of the student physician. Areas included are: philosophy of palliative care, communication skills, symptom assessment and control, approach to ethical issues, decision making and interdisciplinary team function. The authors describe the university's current approach in its specific contribution to undergraduate and postgraduate medical education, the continuum throughout those years and an examination of recommendations for the future.

scholarly journals Visitor Restrictions, Palliative Care, and Epistemic Agency: A Qualitative Study of Nurses’ Relational Practice During the Coronavirus Pandemic

2021 ◽  
Vol 8 ◽  
pp. 233339362110517
Author(s):  
Kim McMillan ◽  
David K. Wright ◽  
Christine J. McPherson ◽  
Kristina Ma ◽  
Vasiliki Bitzas
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Moral Agency ◽  
Ethical Issues ◽  
Ethical Reasoning ◽  
Epistemic Agency ◽  
Relational Practice ◽  
Philosophy Of Palliative Care ◽  
Pandemic Response

Efforts to curb spread of COVID-19 has led to restrictive visitor policies in healthcare, which disrupt social connection between patients and their families at end of life. We interviewed 17 Canadian nurses providing palliative care, to solicit their descriptions of, and responses to, ethical issues experienced as a result of COVID-19 related circumstances. Our analysis was inductive and scaffolded on notions of nurses’ moral agency, palliative care values, and our clinical practice in end-of-life care. Our findings reveal that while participants appreciated the need for pandemic measures, they found blanket policies separating patients and families to be antithetical to their philosophy of palliative care. In navigating this tension, nurses drew on the foundational values of their practice, engaging in ethical reasoning and action to integrate safety and humanity into their work. These findings underscore the epistemic agency of nurses and highlight the limits of a purely biomedical logic for guiding the nursing ethics of the pandemic response.

Palliating oncologists: A pilot study on primary palliative care development in hematology-oncology trainee outpatient clinics.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 21-21
Author(s):  
Erin R. Alesi ◽  
Sherri Rauenzahn ◽  
Laurel Lyckholm
Keyword(s):  
Palliative Care ◽  
Intervention Group ◽  
Symptom Burden ◽  
Symptom Assessment ◽  
Comfort Level ◽  
Control Group ◽  
Before And After ◽  
And Control ◽  
Short Answer Questions

21 Background: Primary Palliative Care (PPC) denotes basic PC competencies; whereas secondary PC (SPC) denotes consultant expertise. PPC competency includes basic symptom assessment/management; fundamental communication skills; and identification of patients for SPC. ASCO recommends early concurrent PC in advanced cancer/high symptom burden as it improves quality of life, symptom management, and care satisfaction. Because PC need exceeds availability of SPC providers, PPC proficiency by oncologists is essential. To enhance Hematology-Oncology (HO) fellows’ clinical experience through more effective PC training/utilization, we piloted an integrated fellows’ pre-clinic conference. Methods: HO fellows’ pre-clinic conferences were divided into intervention and control groups. Over 8 weeks, the PC fellow participated in interdisciplinary discussion for 2 weekly 1-hour conferences. The PC fellow provided PPC education via brief formal and informal didactics and identified patients for SPC referral. All HO fellows were surveyed before and after the intervention to assess comfort level with PPC and SPC referral. The survey used Likert-type scales and short-answer questions. Results: All HO fellows (N=10) voluntarily participated: 6 in the intervention group (IG), and 4 in the control group (CG). The IG demonstrated clearly enhanced comfort level with managing symptoms by improving in 100% of PPC categories after the intervention compared to 27% in the CG. Referral to SPC also increased in the IG, while it decreased in the CG. All HO fellows in the IG liked the PC integration, wanted to continue it, and wanted SPC availability in their future practice. Conclusions: This integration not only enhanced HO fellows’ PPC training and increased referral to SPC; it also fostered a partnership between HO and PC providers early in their careers. Such collaborative efforts are likely to improve long-term comprehensive cancer care as well as patient and provider satisfaction. Further study is merited and should include multiple centers and patient evaluations.

scholarly journals Quality Improvement in Cancer Symptom Assessment and Control: The Provincial Palliative Care Integration Project (PPCIP)

2012 ◽  
Vol 43 (4) ◽  
pp. 663-678 ◽  
Author(s):  
Julie E. Gilbert ◽  
Doris Howell ◽  
Susan King ◽  
Carol Sawka ◽  
Erin Hughes ◽  
...  
Keyword(s):  
Palliative Care ◽  
Quality Improvement ◽  
Symptom Assessment ◽  
Care Integration ◽  
Integration Project ◽  
And Control

Status of palliative care education in Mainland China: A systematic review

2020 ◽  
pp. 1-11
Author(s):  
Antonia M. Willemsen ◽  
Stephen Mason ◽  
Silja Zhang ◽  
Frank Elsner
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
Medical Education ◽  
Postgraduate Medical Education ◽  
Mainland China ◽  
Detailed Knowledge ◽  
Special Importance ◽  
Care Education ◽  
Palliative Care Education ◽  
Education In China

Abstract Objective China is home to one-fifth of the world's population. In the setting of a growing and aging population as well as the designation of palliative care access as a human right in 2013, the implementation of palliative care in China gains special importance. Palliative care education is an important precondition to ensure a nationwide access to palliative care. This systematic review details the status of under- and postgraduate palliative care education in China, examining both the students’ and physicians’ perception, knowledge, and skills in palliative care, and the available educational interventions and programs. Method Four databases were searched in September 2018, using considered search terms. Titles, abstracts, and, if necessary, full texts were scanned to identify publications matching the inclusion criteria. Results Nine publications were included. They revealed six findings: palliative care education is lacking in both under- and postgraduate medical education, only a few programs exist. Palliative care as a concept is well known, detailed knowledge, and practical skills are less developed. Chinese physicians consider palliative care an important field to be developed in cancer care, yet the majority of healthcare professionals are not willing to work in palliative care services. Communication should be a main emphasis in palliative care education, especially in undergraduate training. Finally, there is no highly qualified research on under- or postgraduate palliative care education in Mainland China. Significance of results These findings suggest that palliative care education in China is in demand and should be systematically integrated into medical education. Further research on the topic is urgently needed.

scholarly journals Integration of a Mandatory Palliative Care Education Into Hematology-Oncology Fellowship Training in a Comprehensive Cancer Center: A Survey of Hematology Oncology Fellows

2019 ◽  
Vol 15 (11) ◽  
pp. e934-e941 ◽  
Author(s):  
Suresh K. Reddy ◽  
Kimberson Tanco ◽  
Sriram Yennu ◽  
Diane D. Liu ◽  
Janet L. Williams ◽  
...  
Keyword(s):  
Palliative Care ◽  
Terminal Illness ◽  
Ethical Issues ◽  
Symptom Assessment ◽  
Fellowship Training ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Do Not Resuscitate ◽  
Coping With Stress ◽  
Opioid Prescription

PURPOSE: The primary aim of this study was to determine the attitudes and beliefs of hematology and medical oncology (HMO) fellows regarding palliative care (PC) after they completed a 4-week mandatory PC rotation. METHODS: The PC rotation included a 4-week standardized curriculum covering all PC domains. HMO fellows were provided educational materials and attended all didactic sessions. All had clinical rotation in an acute PC unit and an outpatient clinic. All HMO fellows from 2004 to 2017 were asked to complete a 32-item survey on oncology trainee perception of PC. RESULTS: Of 105 HMO fellows, 77 (73%) completed the survey. HMO fellows reported that PC rotation improved assessment and management of symptoms (98%); opioid prescription (89%), opioid rotation (78%), and identification of opioid adverse effects (87%); communication with patients and families (91%), including advance care planning discussion (88%) and do-not-resuscitate discussion (88%); and they reported comfort with discussing ethical issues (74%). Participants reported improvement in knowledge of symptom assessment and management (n = 76; 98%) as compared with efficacy in ethics (n = 57 [74%]; P = .0001) and for coping with stress of terminal illness (n = 45 [58%]; P = .0001). The PC rotation educational experience was considered either far better or better (53%) or the same (45%) as other oncology rotations. Most respondents (98%) would recommend PC rotations to other HMO fellows, and 95% felt rotation should be mandatory. CONCLUSION: HMO fellows reported PC rotation improved their attitudes and knowledge in all PC domains. PC rotation was considered better than other oncology rotations and should be mandatory.

Attitudes and beliefs of a mandatory palliative care rotation by hematology and medical oncology fellows at a major comprehensive cancer center.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 98-98
Author(s):  
Suresh Reddy ◽  
Kimberson Cochien Tanco ◽  
Diane D. Liu ◽  
Janet L. Williams ◽  
Sriram J. Yennu ◽  
...  
Keyword(s):  
Palliative Care ◽  
Terminal Illness ◽  
Ethical Issues ◽  
Medical Oncology ◽  
Symptom Assessment ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Attitudes And Beliefs ◽  
Opioid Prescription ◽  
Strongly Agree

98 Background: The ACGME requires incorporating palliative care (PC) competencies into Hematology and Medical Oncology (HMO) fellowship curriculum. The primary aim of this study was to determine the attitudes and beliefs regarding PC of HMO fellows who completed a 4 week mandatory PC rotation. Methods: The rotation included a 4 week standardized curriculum covering all PC domains and all HMO fellows rotated in acute palliative care unit (APCU), consult service and outpatient clinic. HMO fellows were provided educational materials and attended all didactic sessions. All HMO fellows from 2004 to 2017 were sent a 39 item survey adapted from published studies on oncology trainee perception of PC. Results: 77/105 (73%) HMO fellows completed the survey (median age of 40 years, 57% males and 82% practicing in an academic setting). The following were reported to improve after the PC rotation: (a) assessment and management of symptoms (98%); (b) opioid prescription (89%), opioid rotation (78%) and identification of opioid side effects (87%); (c) communication with patients and families (91%), advance care planning discussion (88%), DNR discussion (88%); (d) comfort discussing ethical issues (74%); (e) ability to cope with stress of terminal illness (58%). Strongly agree to agree was expressed by 76 (98%) for improved knowledge of symptom assessment & management vs 57 (74%) for ethics (p = 0.0001) and 45 (58%) for coping with stress of terminal illness (p = 0.0001). HMO fellows were more likely to refer patients to PC (83%) for uncontrolled symptoms (97%), psychological distress (88%) or with advanced disease regardless of symptoms (56%) after the rotation. The APCU rotation was felt to be most beneficial (93%). The PC rotation educational experience was felt to be either far better or better (53%) or same (45%) as other oncology rotations. 98% would recommend PC rotations to other HMO fellows and 95% felt rotation should be mandatory. Conclusions: HMO fellows reported PC rotation improved their knowledge in all PC domains, felt PC rotation was far better to better than other oncology rotations, and were more likely to refer patients to PC.

Research Participation Experiences of Informants of Suicide and Control Cases

Crisis ◽  
2010 ◽  
Vol 31 (5) ◽  
pp. 238-246 ◽  
Author(s):  
Paul W. C. Wong ◽  
Wincy S. C. Chan ◽  
Philip S. L. Beh ◽  
Fiona W. S. Yau ◽  
Paul S. F. Yip ◽  
...  
Keyword(s):  
Ethical Issues ◽  
Research Participation ◽  
Self Report ◽  
Initial Contact ◽  
Psychological Autopsy ◽  
Autopsy Study ◽  
The People ◽  
And Control ◽  
The Impact

Background: Ethical issues have been raised about using the psychological autopsy approach in the study of suicide. The impact on informants of control cases who participated in case-control psychological autopsy studies has not been investigated. Aims: (1) To investigate whether informants of suicide cases recruited by two approaches (coroners’ court and public mortuaries) respond differently to the initial contact by the research team. (2) To explore the reactions, reasons for participation, and comments of both the informants of suicide and control cases to psychological autopsy interviews. (3) To investigate the impact of the interviews on informants of suicide cases about a month after the interviews. Methods: A self-report questionnaire was used for the informants of both suicide and control cases. Telephone follow-up interviews were conducted with the informants of suicide cases. Results: The majority of the informants of suicide cases, regardless of the initial route of contact, as well as the control cases were positive about being approached to take part in the study. A minority of informants of suicide and control cases found the experience of talking about their family member to be more upsetting than expected. The telephone follow-up interviews showed that none of the informants of suicide cases reported being distressed by the psychological autopsy interviews. Limitations: The acceptance rate for our original psychological autopsy study was modest. Conclusions: The findings of this study are useful for future participants and researchers in measuring the potential benefits and risks of participating in similar sensitive research. Psychological autopsy interviews may be utilized as an active engagement approach to reach out to the people bereaved by suicide, especially in places where the postvention work is underdeveloped.

In memory of professor L.S. Rosenstrauch. To the 100th anniversary

2019 ◽  
pp. 131-135
Author(s):  
T. Sh. Morgoshiia ◽  
N. A. Syroezhin
Keyword(s):  
Medical Education ◽  
Nuclear Medicine ◽  
Board Member ◽  
Postgraduate Medical Education ◽  
Editorial Board Member ◽  
100Th Anniversary ◽  
Honorary Member ◽  
Scientific Papers ◽  
Important Direction

The article presents the main stages of life and work of the professor L.S. Rosenstrauch (1918–2016). L.S. Rosenstrauch is the author of more than 300 scientific papers including 10 monographies. The important direction of his scientific works was development of new radiological techniques such as parasternal mediastinography, and development and integration of the domestic contrast agents. L.S. Rosenstrauch intensively engaged in teaching. More than 30 doctoral and more than 60 candidate dissertations were defended under his guidance or consultation. Professor was a honorary member of domestic and foreign societies of radiology, editorial Board member of the “Journal of radiology and nuclear medicine” and the international journal “Radiology – diagnostics”, coeditor of radiological section of the BME. Under his guidance a unified program of postgraduate medical education in radiology was developed.

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