scholarly journals Educating for Compassion: Detoxifying Death for Physicians' CME Curriculum

2001 ◽  
Vol 6 (2) ◽  
pp. 157-164
Author(s):  
Rachel Naomi Remen ◽  
Mary Wade
Keyword(s):  
End Of Life ◽  
Behavioral Change ◽  
Medical Training ◽  
Death And Dying ◽  
The United States ◽  
Professional Staff ◽  
Educational Process ◽  
Leadership Role ◽  
Childhood Memories ◽  
Wide Range

The physician can play a leadership role in detoxifying death for the patient, the family, and the professional staff. However, physicians commonly manifest avoid ance and other dysfunctional behaviors when dealing with death. Dysfunctional physician behaviors around death are not rooted in cognitive understanding and are resistant to conventional didactic approaches (SUPPORT Principal Investigators, 1995). Physician responses to end-of-life patients are affected by the power of childhood memories, personal beliefs, attitudes and unexamined conclusions drawn from medical training. To affect behavioral change, a curriculum was developed that creates an intensive community of inquiry among physician peers to examine existing beliefs in depth and to motivate, validate, and support new behaviors. The curriculum on Detoxifying Death for Physicians was implemented 12 times over a three-year period. Physicians from the United States and Canada, representing a wide range of specialties and practice styles, participated in the curriculum. Participants reported significant attitudinal and behavioral change in the direction of increased comfort in caring for patients at the end of life and in discussing death and dying with colleagues. The Institute for the Study of Health and Illness's (ISHI) experience with this multimodal curriculum suggests that it is possible for mature physicians to significantly alter their attitudes and behaviors toward end-of-life patients through participation in an intensive educational process. It also suggests that change may be a function of the depth and integrity of the educational process rather than the length of exposure to the curriculum.

The Oxford Handbook of Ethics at the End of Life

2014 ◽  
Keyword(s):  
End Of Life ◽  
Assisted Suicide ◽  
Clinical Decision Making ◽  
Death And Dying ◽  
The United States ◽  
Dark Side ◽  
Human Beings ◽  
Cultural Issues ◽  
Physician Assisted Suicide ◽  
Persons With Disabilities

This handbook explores the topic of death and dying from the late twentieth to the early twenty-first centuries, with particular emphasis on the United States. In this period, technology has radically changed medical practices and the way we die as structures of power have been reshaped by the rights claims of African Americans, women, gays, students, and, most relevant here, patients. Respecting patients’ values has been recognized as the essential moral component of clinical decision making. Technology’s promise has been seen to have a dark side: it prolongs the dying process. For the first time in history, human beings have the ability to control the timing of death. With this ability comes a responsibility that is awesome and inescapable. How we understand and manage this responsibility is the theme of this volume. The book has six sections. Section I examines how the law has helped shape clinical practice, emphasizing the roles of rights and patient autonomy. Section II focuses on specific clinical issues, including death and dying in children, continuous sedation as a way to relieve suffering at the end of life, and the problem of prognostication in patients who are thought to be dying. Section III considers psychosocial and cultural issues. Section IV discusses death and dying among various vulnerable populations, such as the elderly and persons with disabilities. Section V deals with physician-assisted suicide and active euthanasia (lethal injection). Finally, Section VI looks at hospice and palliative care as ways to address the psychosocial and ethical problems of death and dying.

Transformative Advance Care Planning: The Honoring Choices Minnesota Experience

2013 ◽  
Vol 19 (4) ◽  
pp. 200-204 ◽  
Author(s):  
Barbara Greene
Keyword(s):  
United States ◽  
Health Care ◽  
End Of Life ◽  
Advance Care Planning ◽  
Medical Condition ◽  
Death And Dying ◽  
The United States ◽  
Care Planning ◽  
Advance Care ◽  
Voluntary Community

In the United States, discussing end-of-life wishes and preferences has been taboo ever since death and dying moved from a stage of life to a medical condition. This article describes the transformative nature of a Minnesota health care initiative, Honoring Choices Minnesota (HCM). As the world’s largest nongovernmental, voluntary community-centered initiative, HCM is changing the culture around speaking of death and dying, one conversation at a time.

A 40-Year History of End-of-Life Offerings in US Medical Schools: 1975-2015

2016 ◽  
Vol 34 (6) ◽  
pp. 559-565 ◽  
Author(s):  
George E. Dickinson
Keyword(s):  
Palliative Care ◽  
Medical Students ◽  
End Of Life ◽  
Geriatric Medicine ◽  
Death And Dying ◽  
Medical Schools ◽  
The United States ◽  
Institute Of Medicine ◽  
Undergraduate Medical Students ◽  
Frequency Distributions

The purpose of this longitudinal study of US medical schools over a 40-year period was to ascertain their offerings on end-of-life (EOL) issues. At 5-year intervals, beginning in 1975, US medical schools were surveyed via a questionnaire to determine their EOL offerings. Data were reported with frequency distributions. The Institute of Medicine has encouraged more emphasis on EOL issues over the past 2 decades. Findings revealed that undergraduate medical students in the United States are now exposed to death and dying, palliative care, and geriatric medicine. The inclusion of EOL topics has definitely expanded over the 40-year period as findings reveal that US undergraduate medical students are currently exposed in over 90% of programs to death and dying, palliative care, and geriatric medicine, with the emphasis on these topics varying with the medical programs. Such inclusion should produce future favorable outcomes for undergraduate medical students, patients, and their families.

The Role of Primary Care Physicians in Providing End-of-Life Care

2018 ◽  
Vol 36 (3) ◽  
pp. 249-254 ◽  
Author(s):  
Jan Tse Liu ◽  
Iris Kovar-Gough ◽  
Nabila Farabi ◽  
Frank Animikwam ◽  
Sarah Beth Weers ◽  
...  
Keyword(s):  
Primary Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Primary Care Physicians ◽  
The United States ◽  
Narrative Review ◽  
Cochrane Library ◽  
Life Care ◽  
Number Of Patients ◽  
Wide Range

Background: Primary care physicians (PCPs) frequently have long-term relationships with patients as well as their families. As such they are well positioned to care for their patients at the end of their lives. As the number of patients in need of end-of-life care continues to grow, it is critical to understand how PCPs can fulfill that need. The purpose of our study is to perform a narrative review of the literature and develop a theoretical model delineating the overarching roles played by PCPs in caring for patients at the end of life. Methods: For this narrative review, the authors searched Medline (PubMed), Embase, Cochrane Library, and Scopus up to March 22, 2017. Articles were not limited by geography. Results: Review of existing literature generally supports 4 broad categories as the primary roles for PCP involvement in end of life: pain and symptom management; information management, including transmitting and clarifying information, setting care priorities, and assisting patients with treatment decisions; coordinating care and collaborating with other providers; and addressing patients’ social, emotional, and spiritual needs. Conclusions: Based on the results of this review, PCPs provide a wide range of services to patients at the end of life. Promoting the provision of the full scope of services by PCPs will help ensure improved continuity of care while providing the highest quality of care for patients, both in the United States and around the world.

Approaches to Death and Dying

2015 ◽  
Vol 70 (3) ◽  
pp. 301-316 ◽  
Author(s):  
Darla D. Beaty
Keyword(s):  
United States ◽  
End Of Life ◽  
Ethical Issues ◽  
Life Experiences ◽  
Death And Dying ◽  
The United States ◽  
Political Factors ◽  
Faith Based ◽  
Islam And Christianity ◽  
End Of Life Decision

Three principles that guide the bioethics movement in the United States and other Western societies apply to the approaches of death and dying in both the United States and Turkey. These three principles, Autonomy, Beneficence, and Justice, are reflected in the practices of people in both countries. The issue of autonomy is of greater concern to those in the United States, while decisions are made entirely with family and physician involvement in Turkey. Beneficence and Justice can be identified as ethical issues in both countries. Similarities with end-of-life experiences are linked by faith-based beliefs of Islam and Christianity. Differences in sociocultural influences, such as policies about advance directives in the United States, account for differences in end-of-life decision making. This article examines the spiritual, cultural, legal, and political factors that inform the experience of people in Turkey and in the United States when death is at hand.

scholarly journals Bringing Life to Death: The Need for Honest, Compassionate, and Effective End-of-Life Conversations

2020 ◽  
pp. 476-484
Author(s):  
Amy R. MacKenzie ◽  
Michelle Lasota
Keyword(s):  
End Of Life ◽  
Nurse Practitioners ◽  
Medical Training ◽  
Death And Dying ◽  
Vital Role ◽  
Cultural Barriers ◽  
Care Providers ◽  
Public Health Agencies ◽  
Health Agencies ◽  
Crucial Part

Conversations about death and dying are a crucial part of all medical care and are particularly relevant in the field of oncology. Patients express a desire to have discussions about goals of care, and many patients have thought about their end-of-life (EOL) wishes but have not had an opportunity to openly talk with care providers about this. Deficiencies in medical training, lack of confidence, limited time, and cultural barriers all contribute to the paucity of these important discussions. Although physicians are often expected to lead these conversations, nurses and nurse practitioners also play a vital role in the identification of opportunities to address EOL goals and should be a resource for the care team in facilitating EOL conversations at all points on the care continuum. Public engagement is paramount in normalizing conversations about death and dying, and the health care system needs to partner with public health agencies and private groups to open dialogues about EOL. Providers at all levels need improved education in having these difficult but essential conversations.

scholarly journals ORGANIZATIONAL AND DIDACTIC FEATURES OF SOCIAL REHABILITATION STUDENTS’ PROFESSIONAL TRAINING IN THE USA

2021 ◽  
pp. 68-71
Author(s):  
J. DEMCHENKO
Keyword(s):  
Problem Solving ◽  
Information And Communication Technologies ◽  
Professional Training ◽  
Real Life ◽  
The United States ◽  
Educational Process ◽  
Interactive Technologies ◽  
Academic Degree ◽  
Social Rehabilitation ◽  
Wide Range

The article analyzes organizational and content features of social rehabilitation students’ professional training at higher education institutions in the United States. The two-year college programs for obtaining Associate’s degree, four-year Bachelor’s and interdisciplinary Master’s degree university programs for professional training in social rehabilitation have been characterized. The peculiar features of these programs for each academic degree have been determined. It has been identified that professional training is carried out on an interdisciplinary basis by integrating general scientific, professional and subject-specific knowledge, introducing wide range of elective courses. Three models for training social rehabilitation students have been defined: traditional didactic, problem-solving and facilitated. Preference is given to the facilitated model, the conceptual idea of which is the idea of an integral professional and personal development of a social rehabilitation student as a subject of educational process throughout the study period and further professional activities. According to these models, the key teaching technologies have been divided into three groups: traditional didactic (demonstration, asking and answering questions), problem-solving (discussions, problem-based situations, conversations) and facilitated (interactive technologies such as round-table discussions, brainstorming activities, case study etc.). It has been found out that American college and university teachers prefer interactive (group learning, gaming, reflective, combined, integrated, project-based, information and communication) technologies, the essential features of which are the problem-based nature of co-operative learning, partnership and dialogue. Effective use of interactive technologies helps to involve students in the process of cognition, develops students’ critical thinking, encourages them to participate in learning activities, become independent, develop their professional outlook, reflect upon their own educational and cognitive activities by promptly defining their learning outcomes, modeling real life situations, creating the atmosphere of community and co-operation. It has been found out that the system of professional training provides conditions for professional self-determination, self-development and self-improvement.

Why Is It Just So Hard? Making Sense of End-of-Life Communication Between Adult Children and Their Terminally Ill Parental Figures

2019 ◽  
pp. 003022281985916
Author(s):  
Emily Scheinfeld ◽  
Pamela K. Lake
Keyword(s):  
End Of Life ◽  
Adult Children ◽  
Death And Dying ◽  
The United States ◽  
Health Conditions ◽  
Need For Care ◽  
Making Sense ◽  
Parental Figures ◽  
End Of Life Communication ◽  
Control Family

The aging population in the United States is predicted to become one fifth of the population by 2050. With that increase, more individuals in the country will be experiencing chronic health conditions and the need for care, with end of life (EoL) becoming more of a topic that needs to be discussed. This study aims to explore the ways adult children talk to their parents about EoL, death, and dying. We discovered six themes: protection, meeting needs, guilt and regret, control, family dynamics, and communication type. Each of these was prevalent in responses to how adult children cope, how they cared for their parent, and how hope played into the interactions. We believe these themes will be helpful in developing a quantitative scale to study EoL further and be practical in helping adult children cope following death of their parent.

Death and End of Life: Perceptions Throughout The Career About Death, Palliative Care, and Educational Process

2020 ◽  
pp. 082585972092343
Author(s):  
Maria Luiza Galoro Corradi ◽  
Etienne Duim ◽  
Cibele Isaac Saad Rodrigues
Keyword(s):  
Palliative Care ◽  
Clinical Practice ◽  
Medical Students ◽  
Medical School ◽  
End Of Life ◽  
Death And Dying ◽  
Educational Process ◽  
Undergraduate Medical Students ◽  
Cross Sectional ◽  
Attending Physicians

Purpose: To evaluate the perception of attending physicians, medical residents, and undergraduate medical students about death and dying, the end of life (EoL), and palliative care (PC) during training and clinical practice, highlighting knowledge gaps, and the changes needed in medical school curricula. Method: Cross-sectional study of 12 attending physicians, residents, and undergraduate medical students randomly selected from a single teaching hospital in São Paulo, Brazil, 2018. Semi-structured interviews were conducted, transcripts were coded in depth, and categorizing analysis was carried out. Results: Three topical categories were recognized: Negative feelings about death and the EoL, importance of PC, and gaps in curricular structure hindering preparedness for PC and EoL communication. Besides differing perspectives depending on their years of experience, all participants strongly endorsed that the current medical school curriculum does not train and support physicians to handle EoL and PC. Conclusions: Medical education plays a fundamental role in the development of knowledge and skills on death, dying, and PC. Such practices should extend throughout the course and be continuously improved after graduates move to clinical practice.

scholarly journals “Do Not Protect Us, Train Us.”—Swiss Healthcare Students’ Attitudes Toward Caring for Terminally Ill Patients

2021 ◽  
pp. 003022282110070
Author(s):  
Typhaine Maïko Juvet ◽  
Marc-Antoine Bornet ◽  
Jean-François Desbiens ◽  
Diane Tapp ◽  
Pauline Roos
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Death And Dying ◽  
Terminally Ill ◽  
Educational Process ◽  
Life Care ◽  
Healthcare Students ◽  
Terminally Ill Patients ◽  
Students Attitudes ◽  
Professional Fulfillment

Positive attitudes and a sense of competence toward end-of-life care are the key to adequately support terminally ill patients. This qualitative study aims to explore healthcare students’ attitudes toward caring for terminally ill patients. Eleven students from the University of Applied Health Sciences in Switzerland participated in focus groups. Attitudes were overall positive. Most participants felt that supporting dying patients was a way to achieve professional fulfillment. However, most students felt not competent in palliative care and lacking experience. They wanted to receive better training, more specifically in good practices and appropriate behaviors. Our study fills a knowledge gap regarding the opinions and pedagogical needs of healthcare students, and highlights the importance of experiencing end-of-life care during the educational process. We recommend early exposure to terminally ill patients and appropriate attitudes toward death and dying as part of the bachelor’s curriculum, accompanied by benevolent guidance from teachers and health professionals.

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