Corresponding about death: Analyzing letters from patients with cancer to medical students.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 11021-11021
Author(s):  
Tianyi Zhang ◽  
Mekaleya Tilahun ◽  
Cynthia Perlis ◽  
Sam Brondfield
Keyword(s):  
Medical Students ◽  
End Of Life ◽  
Death And Dying ◽  
Severe Illness ◽  
Clinical Environment ◽  
Patients With Cancer ◽  
Coping Process ◽  
Award Winning ◽  
Multiple Paths ◽  
One Year

11021 Background: Clinicians frequently discuss death and dying with patients who have cancer. However, the doctor-patient hierarchy and the unfamiliar clinical environment may prevent these patients from discussing death and dying authentically. Patients may feel more comfortable expressing themselves when given the time and space to write at home. Firefly, an award-winning program at UCSF, facilitates written correspondence between patients with cancer and medical students over the course of one year. Firefly’s archive contains thousands of patient letters and constitutes a unique resource for analyzing authentic patient expression outside of the clinical context. The aim of the current study is to improve curricula pertaining to severe illness and end-of-life by providing educators with an analysis of authentic patient perspectives about death and dying expressed in these letters. Methods: We (two medical students, an expressive artist, and an oncologist) read all Firefly letters written by patients between 2014 and 2019 and identified 12 patients whose letters meaningfully discussed death or dying. We performed a thematic analysis of these letters using the Buckman three-stage model of dying as a reference. Results: Four themes emerged: turmoil; grief; making peace; and past, present and future. The first three themes aligned with the Buckman stages. The fourth theme—past, present and future—spanned the three stages and also elaborated the Buckman model by describing multiple paths that patients may take after passing through these stages. Conclusions: The authentic ways in which patients with cancer discussed death and dying in their letters provided deep insight into their coping process. The Buckman model appears useful for framing death and dying from the patient perspective but may not fully reflect modern oncologic care in which many patients live for years beyond a severe or terminal diagnosis. Educators can use the identified themes to shape medical school curricula pertaining to severe illness and end-of-life care.

Communicating With Dying Patients and Their Families: Multimedia Training in End-of-Life Care

2016 ◽  
Vol 34 (7) ◽  
pp. 637-644 ◽  
Author(s):  
Phylliss M. Chappell ◽  
Jennifer Healy ◽  
Shuko Lee ◽  
Glen Medellin ◽  
Sandra Sanchez-Reilly
Keyword(s):  
Medical Students ◽  
End Of Life ◽  
Attitude Change ◽  
Positive Attitude ◽  
Death And Dying ◽  
Signs And Symptoms ◽  
Computer Application ◽  
Fisher Exact Test ◽  
Positive Attitudes ◽  
Dying Patients

Background: The need for end-of-life (EOL), high-impact education initiatives to prepare medical students to communicate with dying patients and their families and to cope with issues of death and dying, is well recognized. Methods: Third-year medical students (n = 224), during their ambulatory rotation, completed a multimedia EOL curriculum, which included pre-/posttests, an online case-based module, didactic presentation, and a tablet computer application designed to demonstrate the signs and symptoms seen in the last hours of life for families of dying patients. Pre- and posttests were compared using Pearson χ2 or Fisher exact test, and improvement was measured by weighted κ coefficient. Results: On preintervention surveys, the majority of students demonstrated positive attitudes toward the care of dying patients and their families. Despite this high pretest positive attitude, there was a statistically significant overall positive attitude change after the intervention. The lowest pretest positive attitudes and lowest posttest positive attitude shifts, although all statistically improved, involved addressing the thoughts and feelings of dying patients and in coping with their own emotional response. Conclusions: Medical students exposure to this multimedia EOL curriculum increases positive attitudes in caring for dying patients and their families.

Multiple chronic conditions and intensity of end-of-life care among patients with cancer.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 47-47
Author(s):  
Cara L. McDermott ◽  
Ruth Engelberg ◽  
Mohamed Lotfy Sorror ◽  
James Sibley ◽  
J. Randall Curtis
Keyword(s):  
End Of Life ◽  
High Intensity ◽  
Chronic Conditions ◽  
Chronic Renal Disease ◽  
Functional Limitation ◽  
Organ Damage ◽  
Severe Illness ◽  
Multiple Chronic Conditions ◽  
Patients With Cancer ◽  
Eol Care

47 Background: Multiple chronic conditions (MCCs) are associated with increased intensity of end-of-life (EOL) care in many conditions but their effect has not been well explored in patients with cancer. We examined intensity of EOL care and advance care planning (ACP) by patients with cancer and MCCs versus those without MCCs to better understand how MCCs affect EOL healthcare use in this population. Methods: Our sample included patients with cancer in the UW Medicine system who died between 2010-2017. MCCs were defined using the Dartmouth Atlas of Healthcare for the most common categories of severe illness in the last two years of life. These included chronic pulmonary disease, coronary artery disease (CAD), heart failure, severe chronic liver disease, chronic renal disease, dementia, diabetes with end organ damage, or peripheral vascular disease. Patients were categorized as having none or 1+ MCCs. We used a claims-based indicator for the presence of functional limitation. Outcomes included ACP documentation in the electronic health record, death in hospital, and inpatient or ICU admission in the last month of life. We performed logistic regression for all outcomes controlling for confounders defined a priori (age at death, race, sex, marital status, insurance, education, functional limitation). Results: Of 15,092 patients with cancer, 10,596 (70%) had 1+MCCs (range 1-8 MCCs). Common MCCs were pulmonary (25%), CAD (23%), and renal (18%). Those with MCCs were older (median 66 years (range 18-104) vs 63 years (range 18-102)), with more functional limitations (65% vs 43%). Those with 1+ MCC had more ACP documentation (43% vs. 23%) compared to those with no MCCs. Patients with 1+ MCC were more likely to die in hospital (OR 1.86, 95% CI 1.72-2.02) and to have inpatient (OR 2.45, 95% CI 2.20-2.72) or ICU admissions (OR 2.95, 95% CI 2.55-3.42) in their last 30 days versus patients with cancer and no MCCs. Conclusions: Among patients with cancer in a single healthcare system, patients with cancer and MCCs were more likely to have ACP documentation, die in hospital and experience high-intensity hospital-based care at or near EOL. Further research is needed to explore if such high-intensity care is aligned with patient and family goals for care.

Respecting patient choices: using the ’Go Wish' cards as a teaching tool

2017 ◽  
Vol 8 (2) ◽  
pp. 194-197 ◽  
Author(s):  
Hibah Osman ◽  
Katia El Jurdi ◽  
Ramzi Sabra ◽  
Thalia Arawi
Keyword(s):  
Palliative Care ◽  
Medical Education ◽  
Medical Students ◽  
End Of Life ◽  
Thematic Analysis ◽  
Death And Dying ◽  
Teaching Tool ◽  
Student Reflection ◽  
Second Year ◽  
Self Discovery

BackgroundIndividuals have different values and priorities that can have an important impact on their medical management. Understanding this concept can help physicians provide medical care that is in line with the goals of their patients. Communicating this message effectively to students is challenging.ObjectiveTo report our experience with using Go Wish cards in the medical education setting.DesignA thematic analysis of student reflection papers using grounded theory.Setting/SubjectsSecond-year medical students participated in an activity using the Go Wish cards as part of a course module on palliative care. The activity aimed to encourage students to reflect on their own choices at the end of life and to highlight that different people have different priorities.ResultsForty-two students (42%) mentioned the Go Wish activity in their reflections on the module. They reported that the activity demonstrated the different priorities at the end of life, it illustrated the importance of providing personalised care, it promoted self-discovery, it transformed their view of death and dying, and it increased their appreciation of the importance of palliative care.ConclusionGo Wish cards can be used to help illustrate the variability in priorities of patients. They can be used as an effective to teach medical students about the importance of considering patient preferences when illness progresses.

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.

A national survey of medical students and educators at Korean medical schools, examining the impact of end-of-life care education provided to Korean medical students based on their attitudes.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 55-55
Author(s):  
Do Yeun Kim ◽  
Kyong-Jee Kim ◽  
Sung Joon Shin ◽  
Dae Seog Heo ◽  
Soon-Nam Lee ◽  
...  
Keyword(s):  
Medical Students ◽  
End Of Life ◽  
Death And Dying ◽  
Medical Schools ◽  
Physical Symptoms ◽  
Advanced Directives ◽  
Care Education ◽  
Medical Educators ◽  
Eol Care ◽  
The Impact

55 Background: This study explored the current state of end-of-life (EoL) care education provided to Korean medical students and their self-rated attitudes toward EoL-related education. Methods: An anonymous survey was given to fourth year medical s tudents and the principle EoL care educators at all 41 Korean medical schools. The medical educators were asked to identify the EoL care-related topics that they usually teach students. Both students and medical educators completed seven items regarding self-perceived attitudes. Results: In total, 23 medical educators (56.1%) and 1,545 medical students (46.3%) responded. Of nine topics related to EoL care, the most frequently taught topics were delivering bad news (100%) and managing physical symptoms (74.1%), whereas setting treatment goals was taught the least frequently (37.0%). Approximately half of the educators taught the withdrawal of life-sustaining devices (59.3%), death and dying (55.6%), and advanced directives (55.6%). When the medical students were dichotomized into groups taught at least six topics (n = 815) versus five or fewer topics (n = 729), the group taught at least six topics expressed more satisfaction with EoL care education and they considered EoL care-related issues during their clerkship rotations. They also had fewer negative answers when they were asked about their readiness to practice EoL care. Conclusions: EoL education is inadequate for Korean medical students. However, medical students who were more fully instructed in this topic reported self-rated competency regarding EoL care-related issues. Further research should develop an education system that provides sufficient knowledge and training in EoL care for Korean medical students.

Students’ Experiences With Death and Dying Prior to Medical School: A Content Analysis of Students’ Written Reflections

2019 ◽  
Vol 36 (11) ◽  
pp. 999-1007
Author(s):  
Jaideep S. Talwalkar ◽  
John P. Moriarty ◽  
Matthew S. Ellman
Keyword(s):  
Content Analysis ◽  
Medical Students ◽  
End Of Life ◽  
Student Attitudes ◽  
Hospice Care ◽  
Death And Dying ◽  
Emotional Responses ◽  
Emotional Reactions ◽  
Free Text ◽  
Personal Experiences

Background: Personal experiences with death and dying are common among medical students, but little is known about student attitudes and emotional responses to these experiences. Our objectives were to ascertain matriculating medical students’ experiences with death and dying, describe the range of students’ emotional responses, and identify reactions, behaviors, and perceived roles related to these and future experiences with death. Methods: We provided a writing prompt to newly matriculated medical students asking them to “reflect on experiences you may have had with family or friends near the end of life.” Content analysis was performed to identify themes in the responses. Results: The 104 students in the entering class submitted 90 individual free-text responses (87%). Most (57%) students specifically mentioned at least 1 personal experience with death, with a range of emotional responses including sadness (29%), surprise (14%), and guilt (12%). Distinct themes emerged on content analysis including personal experiences with death, anticipated response to death in future, changes in body or mind of the dying person, thoughts and observations about others, and cognitive or existential responses. Few students wrote about religion or spirituality (8%) or palliative or hospice care (2%). Conclusions: An understanding of students’ premedical school experiences and emotional reactions to death may help educators frame curricula around end-of-life care. Educators could apply enhanced awareness to help students process their own experiences as they begin caring for patients and to focus on areas that were underrepresented in students’ comments, such as religion, spirituality, palliative care, and hospice.

Death and dying

2018 ◽  
pp. 501-516
Author(s):  
Maria Flynn ◽  
Dave Mercer
Keyword(s):  
End Of Life ◽  
Nursing Practice ◽  
Death And Dying ◽  
Health Condition ◽  
Clinical Environment ◽  
Grief And Bereavement ◽  
The Uk

An important aspect of nursing practice is caring for people in the last days and hours of their life, whether in a hospice, a clinical environment, or their own homes. Whilst death may be sudden and unexpected, or the anticipated result of an intractable health condition, the effective support of dying people and their families is an important aspect of nursing and care. The UK Leadership Alliance for the Care of Dying People describes key principles to guide nurses who are working with people and families at the end of life. This chapter discusses these principles and considers how they may be translated into general nursing practices. It also discusses the features of loss, grief, and bereavement, and how nurses may continue to support the bereaved after a person has died.

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 Conversations About Death and Dying, End-of-Life Care Plans and Preferences Between Aging Parents and Adult Children

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 417-417
Author(s):  
Hyo Jung Lee ◽  
Jacobbina Jin Wen Ng
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Adult Children ◽  
End Of Life Care ◽  
Death And Dying ◽  
Family Members ◽  
Life Care ◽  
Joint Decision ◽  
Aging Parents ◽  
Care Plans

Abstract This study aims to investigate whether attitude and perception on late-life death and dying, end-of-life care plans and preferences could be better understood from current values shared between aging parents and their adult children in the multi-cultural city-bound country, Singapore. We are in the process of interviewing 20 aging parent-adult child dyads. Up to date, six semi-structured interviews were completed and transcribed. We performed Content analysis to analyze the transcripts. Preliminary findings showed that both aging parents and adult children rarely discussed this issue, although parents had their own plans or preferences. The major barriers against open conversations about death and dying of aging parents include: the perception of not-yet time to talk about this issue (without knowing when the right time is) and tendency to have conversations about death in tandem with finances, but not death itself. Although specific end-of-life care plans or arrangements were not thought out thoroughly, aging parents expressed a high level of trust and reliance on close family members’ decisions regarding their end-of-life care. They tended to agree on joint decision-making process within family, even though adult children had no or unmatched ideas about their aging parents’ end-of-life wishes. This did not necessarily align with previous findings in Western countries, underscoring individuals’ control over their own death and dying process. Open conversation within family, family-involved advance care planning, or joint decision-making processes may be warranted to promote quality of life and death in older Singaporeans and well-being of their family members of all ages.

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