Exploring End-of-Life Care Team Communication: An Interprofessional Simulation Study

Effective team communication is necessary for the provision of high-quality health care. Yet, recent graduates from diverse health-care disciplines report inadequate training in communication skills and end-of-life care. This study explored the impact of a withdrawal of life-sustaining measures interprofessional simulation on team communication skills of students representing medicine, nursing, and social work. The 3-phase simulation required teams to communicate with the patient, family, and one another in the care of a seriously ill patient at the end of life. Team communication in the filmed simulations was analyzed via the Gap-Kalamazoo Communication Checklist. Results revealed fair to good communication across the 9 communication domains. Overall team communication was strongest in “shares information” and lowest in “understands the patient’s and family’s perspective” domains. Field notes revealed 5 primary themes— Team Dynamics, Awkwardness, Empathy is Everything, Build a Relationship, and Communicating Knowledge When You Have It—in the course of the data analysis. Logistical challenges encountered in simulation development and implementation are presented, along with proposed solutions that were effective for this study. This simulation provided an opportunity for interprofessional health-care provider students to learn team communication skills within an end-of-life care context.

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THE IMPACT OF AN INTERPROFESSIONAL SIMULATION ON TEAM COMMUNICATION AT THE END OF LIFE

Innovation in Aging ◽

10.1093/geroni/igz038.541 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S150-S151

Author(s):

Anne Halli-Tierney ◽

Megan E Lippe ◽

Alexandra Stanley ◽

Allison Ricamato ◽

Robert E McKinney

Keyword(s):

Social Work ◽

Nursing Students ◽

End Of Life ◽

Communication Skills ◽

End Of Life Care ◽

Accurate Information ◽

Life Care ◽

Team Communication ◽

Geriatric Population ◽

The Impact

Abstract It is increasingly important that healthcare professionals understand how to care for patients at the end of life, especially as 75% of hospital deaths occur in the geriatric population. Many new healthcare profession graduates feel under-prepared to provide end-of-life care. Healthcare education programs must provide education on interprofessional communication and end-of-life care. This study explored the effects of an interprofessional end-of-life simulation on medical, social work, and nursing students’ communication skills. Across three simulation phases, teams were required to communicate with the patient (high-fidelity manikin), family members (scripted actors), and team members about treatment option, change in patient’s condition, and withdrawal of life-sustaining measures. A total of 16 teams participated in the simulation, with each team comprised of nursing students (n=7-8), social work students (n=1), and medical students or residents (n=1). Team communication skills were assessed using the Gap Kalamazoo Communication Skills Assessment Form. The average communication score for teams reflected fair to good communication (M=28.81, SD=5.55). The best communication domains were “Shares information” (n=8), “Communicates accurate information” (n=6), and “Builds a relationship” (n=5). The worst domains were “Demonstrates empathy” (n=7), “Provides closure” (n=6), and “Builds a relationship” (n=5). This simulation provides an interactive educational mechanism by which to educate interprofessional healthcare students on communication and care of patients at the end of life.

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“She’s Dying and I Can’t Say We’re Married?”: End-of-Life Care for LGBT Older Adults

The Gerontologist ◽

10.1093/geront/gnaa186 ◽

2020 ◽

Author(s):

Carey Candrian ◽

Kristin G Cloyes

Keyword(s):

Older Adults ◽

Health Care ◽

End Of Life ◽

End Of Life Care ◽

Poor Quality ◽

Life Care ◽

Quality Health Care ◽

Quality Health ◽

Bisexual And Transgender ◽

And Gender

Abstract Lesbian, gay, bisexual, and transgender (LGBT) older adults are at particular risk for receiving inequitable end-of-life care. Their health care wishes may be ignored or disregarded, their families of choice are less likely to be included in their decision making, and they may experience increased isolation, bullying, mistreatment, or abuse, which ultimately contribute to receipt of poor-quality health care. This is particularly important during sensitive transitions along the care continuum to end-of-life settings; 43% of respondents of a 2018 survey of 865 hospice professionals reported having directly observed discriminatory behavior toward LGBT patients. Lack of visibility and accountability perpetuates vulnerabilities and the potential for discriminatory treatment. Unfortunately, while other areas of health care have prioritized and normalized collecting sexual orientation and gender identity (SOGI) data, hospices do not routinely assess patients’ SOGI in the context of end-of-life wishes and decisions. Drawing insight from a sample of 31 in-depth interviews with older LGBT adults, this paper focuses on one participant’s story—Esther’s. We chose her story to illustrate how care can be compromised at the end of life if an open discussion with patients about what and who matters most to them at the end of life, is avoided.

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Refining Patient-Centered Measures of End-of-Life Care Quality for Children With Cancer

JCO Oncology Practice ◽

10.1200/op.21.00447 ◽

2021 ◽

Author(s):

Prasanna Ananth ◽

Sophia Mun ◽

Noora Reffat ◽

Soo Jung Kang ◽

Sarah Pitafi ◽

...

Keyword(s):

Health Care ◽

End Of Life ◽

Health Care Professionals ◽

End Of Life Care ◽

Care Quality ◽

Life Care ◽

Children With Cancer ◽

Symptom Screening ◽

Palliative Care Consultation ◽

Patient Reported

PURPOSE: There are no existing quality measures (QMs) to optimize end-of-life care for children with cancer. Previously, we developed a set of 26 candidate QMs. Our primary objective in this study was to achieve stakeholder consensus on priority measures. METHODS: We conducted an iterative, cross-sectional electronic survey, using a modified Delphi method to build consensus among clinician and family stakeholders. In each of the two rounds of surveys, stakeholders were asked to rate QMs on a 9-point Likert scale, on the basis of perceived importance. Health care professionals were additionally asked to rate measures on perceived feasibility. After each round, we computed median scores on importance and feasibility of measurement, retaining QMs with median importance scores ≥ 8. RESULTS: Twenty-five participants completed both rounds of the survey. In round 1, participants were asked to rate 26 QMs; nine QMs, including QMs pertaining to health care use, were removed because of median importance scores < 8. Two new measures were proposed for consideration in round 2, on the basis of participant feedback. Following round 2, 17 QMs were ultimately retained. QMs related to symptom screening and palliative care consultation were rated highly in importance and feasibility. QMs related to communication were rated highly important, yet less feasible. Measuring whether a patient's needs were heard by their health care team was rated among the least feasible. CONCLUSION: Childhood cancer stakeholders prioritized QMs pertaining to patient-reported outcomes, deeming measures of health care resource use less important. Future research should seek to develop novel tools for quality assessment to enhance feasibility of implementing priority measures.

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On the Margins of Death: A Scoping Review on Palliative Care and Schizophrenia

Journal of Palliative Care ◽

10.1177/0825859718804108 ◽

2018 ◽

Vol 34 (1) ◽

pp. 62-69 ◽

Cited By ~ 7

Author(s):

Erin Relyea ◽

Brooke MacDonald ◽

Christina Cattaruzza ◽

Denise Marshall

Keyword(s):

Health Care ◽

Palliative Care ◽

Access To Care ◽

End Of Life ◽

Health Care Providers ◽

Scoping Review ◽

End Of Life Care ◽

Psychosocial Interventions ◽

Life Care ◽

Care Providers

Schizophrenia is a serious chronic mental illness that results in marginalization and stigma for sufferers. It is the seventh leading cause for disability worldwide. The symptoms of the illness, including hallucinations, delusions, and extremely disordered thinking and behavior, may also introduce barriers to accessing treatment, education, housing, and employment. Little is known about end-of-life care for individuals with schizophrenia. To address this gap, a scoping review was conducted to enhance understanding of hospice and palliative care for patients with schizophrenia. From this scoping review, 342 unique titles and abstracts were identified through a search of 20 databases, including 11 social science databases, 6 medical databases, and 3 gray literature databases. A total of 32 articles met the inclusion criteria and the following 4 themes were identified: Stigma affecting quality of care and access to care; Issues related to consent and capacity for the patient’s end-of-life care decisions and to appoint substitute decision makers; Best practices for psychosocial interventions, pharmacology, family and health-care collaborations, goals of care, setting, and smoking; and Barriers to care, including setting, communication, provider education, and access to care. The review suggests the importance of mandatory interdisciplinary training practices and policy standards outlining cooperative communication across health-care providers. It highlights gaps in evidence-based research on psychosocial interventions and collaborative frameworks to enable the provision of quality end-of-life care for individuals with schizophrenia.

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The Impact of Nursing Homes Staff Education on End-of-Life Care in Residents With Advanced Dementia: A Quality Improvement Study

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2018.10.268 ◽

2019 ◽

Vol 57 (1) ◽

pp. 93-99 ◽

Cited By ~ 6

Author(s):

Paola Di Giulio ◽

Silvia Finetti ◽

Fabrizio Giunco ◽

Ines Basso ◽

Debora Rosa ◽

...

Keyword(s):

Quality Improvement ◽

Nursing Homes ◽

End Of Life ◽

End Of Life Care ◽

Life Care ◽

Advanced Dementia ◽

Staff Education ◽

The Impact

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Nursing care at end of life: a UK-based survey of the deaths of people living in care settings for people with intellectual disability

Journal of Research in Nursing ◽

10.1177/1744987118780919 ◽

2018 ◽

Vol 24 (6) ◽

pp. 366-382 ◽

Cited By ~ 5

Author(s):

Ruth Northway ◽

Stuart Todd ◽

Katherine Hunt ◽

Paula Hopes ◽

Rachel Morgan ◽

...

Keyword(s):

Intellectual Disability ◽

End Of Life ◽

Nursing Care ◽

End Of Life Care ◽

Life Care ◽

Care Providers ◽

Nursing Support ◽

Respiratory Problems ◽

The Uk ◽

The Impact

Background People with intellectual disability are believed to be at risk of receiving poor end-of-life care. Nurses, given their advocacy role and duty to provide compassionate end-of-life care, have the potential to change this situation but research regarding this aspect of their role is limited. Aims This paper thus seeks to answer the question ‘How and when are nurses involved in providing care at end of life for people with intellectual disability?’ Methods A total of 38 intellectual disability care providers in the UK providing support to 13,568 people with intellectual disability were surveyed. Data regarding 247 deaths within this population were gathered in two stages and subsequently entered into SPSSX for analysis. Results Findings revealed that the majority of deaths occurred between the ages of 50 and 69 years, the most commonly reported cause of death being respiratory problems. Both community and hospital-based nurses were involved in supporting individuals during their final 3 months of life, and sometimes more than one type of nurse provided support to individuals. Generally nursing care was rated positively, although room for improvement was also identified. Conclusions Nurses are involved in supporting people with intellectual disability at end of life and appropriate education is required to undertake this role. This may require change in curricula and subsequent research to determine the impact of such change on nursing support to this population.

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