scholarly journals Education is as an important factor in palliative care knowledge: results from a survey of physicians attitudes and knowledge in Palliative Medicine

2020 ◽  
Author(s):  
Thais Ioshimoto ◽  
Danielle Ioshimoto Shitara ◽  
Gilmar Fernandes do Prado ◽  
Raymon Pizzoni ◽  
Rafael Hennemann Sassi ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Palliative Medicine ◽  
Medical Schools ◽  
Medical Residency ◽  
Life Care ◽  
Prior Training ◽  
Palliative Care Education ◽  
Dying Patients

Abstract Background: According to the Latin America Association for palliative care, Brazil offers only 0.48 palliative care services per 1 million inhabitants. In 2012, no accredited physicians were working in palliative care, while only 1.1% of medical schools included palliative care education in their undergraduate curricula. Aim: The aim of the study is to assess medical knowledge in end-of-life care, in order to identify key factors that could be useful in improving palliative care in Brazilian medical schools and residency. Design: Cross sectional study, conducted in São Paulo, Brazil. Students were invited to voluntarily participate in an anonymous and self-administered questionnaire survey. The latter included demographic information, attitudes, prior training in palliative care, prior palliative care experience and the 20-item Palliative Care Knowledge Test (PCKT). Participants: Physicians applying for the medical residency of the Federal University of São Paulo. Results: Of the 3086 subjects, 2349 (76%) answered the survey, 2225 were eligible for analysis while 124 were excluded due to incomplete data. Although the vast majority (99,2%) thought it was important to have palliative care education in the medical curriculum, less than half (46,2%) reported having received any education on palliative care. The overall performance in the PCKT was poor, with a mean score of 10,79 (± 3). While philosophical questions were correctly answered (81,8%), most participants lacked knowledge in symptom control (50,7% for pain, 57,3% for dyspnea, 52,2% for psychiatric and 43,4% for gastrointestinal problems). The high performance group (> 50% of correct answers) had received more training, showed more interest in learning, had a better sense of preparedness, as well as a higher percentage of experience in caring for terminal patients (p<0,001). Conclusions: Our study showed that Brazilian’s physicians lack not only knowledge, but also training in palliative medicine. Important factors to better knowledge in end-of-life care were prior training, previous contact with dying patients and prior medical residency. Corroborating the literature, training showed to be a key factor in overall knowledge. Therefore, medical schools and residency programs should focus on improving palliative training, especially those involving contact with dying patients.

scholarly journals Education is an important factor in end-of-life care: results from a survey of Brazilian physicians’ attitudes and knowledge in end-of-life medicine

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Thais Ioshimoto ◽  
Danielle Ioshimoto Shitara ◽  
Gilmar Fernades do Prado ◽  
Raymon Pizzoni ◽  
Rafael Hennemann Sassi ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Medical Schools ◽  
Medical Residency ◽  
Life Care ◽  
Prior Training ◽  
Care Education ◽  
Palliative Care Education ◽  
Dying Patients

Abstract Background According to the Latin America Association for palliative care, Brazil offers only 0.48 palliative care services per 1 million inhabitants. In 2012, no accredited physicians were working in palliative care, while only 1.1% of medical schools included palliative care education in their undergraduate curricula. As a reflection of the current scenario, little research about end-of-life care has been published so that studies addressing this subject in the Brazilian setting are crucial. Methods A cross-sectional study study conducted with students applying for the medical residency of the Federal University of São Paulo were invited to voluntarily participate in an anonymous and self-administered questionnaire survey. The latter included demographic information, attitudes, prior training in end-of-life care, prior end-of-life care experience, the 20-item Palliative Care Knowledge Test (PCKT) and a consent term. Results Of the 3086 subjects applying for residency, 2349 (76%) answered the survey, 2225 were eligible for analysis while 124 were excluded due to incomplete data. Although the majority (99,2%) thought it was important to have palliative care education in the medical curriculum, less than half of them (46,2%) reported having received no education on palliative care. The overall performance in the PCKT was poor, with a mean score of 10,79 (± 3). While philosophical questions were correctly answered (81,8% of correct answers), most participants lacked knowledge in symptom control (50,7% for pain, 57,3% for dyspnea, 52,2% for psychiatric problems and 43,4% for gastrointestinal problems). Doctors that had already concluded a prior residency program and the ones that had prior experience with terminal patients performed better in the PCKT (p < 0,001). The high-performance group (more than 50% of correct answers) had received more training in end-of-life care, showed more interest in learning more about the subject, had a better sense of preparedness, as well as a higher percentage of experience in caring for terminal patients (p < 0,001). Conclusions Our study showed that Brazilian physicians lack not only the knowledge, but also training in end-of-life medicine. Important factors to better knowledge in end-of-life care were prior training, previous contact with dying patients and prior medical residency. Corroborating the literature, for this group, training showed to be a key factor in overall in this area of knowledge. Therefore, Brazilian medical schools and residency programs should focus on improving palliative training, especially those involving contact with dying patients.

The Development of the Physicians' End-of-Life Care Attitude Scale

2000 ◽  
Vol 40 (2) ◽  
pp. 323-333 ◽  
Author(s):  
Marcia Levetown ◽  
Bert Hayslip ◽  
Jennifer Peel
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Attitude Scale ◽  
Life Care ◽  
Loved One ◽  
Care Education ◽  
Medical Trainees ◽  
Palliative Care Education ◽  
Dying Patients

The Physicians' End-of-Life Care Attitude Scale (PEAS) was developed as an outcome measure for palliative care education. PEAS assesses the willingness of medical trainees to care for dying patients. Sixty-four Likert-type questions were created on the basis of discussions with focus groups of medical trainees, then administered to sixty-two medical students and residents. Total PEAS scores as well as personal preparation and professional role subscales (where higher scores indicated greater concern) possessed excellent internal consistency and reliability. In addition, there were substantial correlations between PEAS scores and the CA-Dying scale, a measure of laypersons' fears about interacting with dying persons. Thus, PEAS adequately assesses the unique communication concerns of physicians in training regarding working with dying persons and their families. Correlations between PEAS scores and age were negative, while those who had experienced the death of a loved one had higher PEAS scores than those who did not. This suggests that for some persons, life experiences may lessen difficulties in dealing with dying persons, while for others, personal losses may exacerbate such concerns. The utility of PEAS in evaluating the efficacy of palliative care education as well as its potential to measure medical trainee's willingness to care for the terminally ill is discussed.

Does post-registration palliative care education for nurses improve practice? A systematic review

2019 ◽  
Vol 25 (11) ◽  
pp. 552-564 ◽  
Author(s):  
Angela Thavaraj ◽  
Karen Gillett
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
End Of Life ◽  
Outcome Measures ◽  
End Of Life Care ◽  
Quantitative Data ◽  
Life Care ◽  
Care Education ◽  
Palliative Care Education ◽  
The Impact

Aims: We aimed to answer the question: what is the evidence that post-registration palliative care education for nurses improves practice? Background: The 2008 End of Life Care Strategy emphasised the need for a workforce equipped to provide high-quality end-of-life care for patients and their families. As registered nurses are the healthcare professionals spending most time with patients and families at the end of life, associated policy documents stress the importance of educating nurses to equip them with the necessary knowledge and skills to provide effective care. Despite education being a consistent recommendation, the ability of education to influence nursing practice is uncertain. Methods: We undertook a systematic review of literature using Joanna Briggs Institute Methodology for Mixed Methods by searching the Medline, Embase and CINAHL databases between January 2006 and December 2018. Findings: Ten studies met the inclusion criteria, seven contained quantitative data. Six demonstrated improvements in outcome measures, but not all results were statistically significant. Most quantitative data related to self-reported measures of confidence. Six studies contained qualitative findings that were categorised into themes: confidence, practice change, skills and proactivity. Conclusion: Little research exists exploring the impact of post-registration palliative care education for nurses. Existing outcome measures do not clearly demonstrate changes to end-of-life practice. Research is suggested to establish links between self-reported confidence and improvements to practice. Evaluation of the impact on practice should be an integral component of end-of-life education initiatives.

End-of-Life Care: Forensic Medicine v. Palliative Medicine

2003 ◽  
Vol 31 (3) ◽  
pp. 365-376 ◽  
Author(s):  
Joseph P. Pestaner
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Forensic Medicine ◽  
End Of Life Care ◽  
Palliative Medicine ◽  
Assisted Suicide ◽  
Life Care ◽  
Care Providers ◽  
Natural Death

The increasing life expectancy of terminally-ill people has raised many public policy concerns about end-of-life care. Due to increased longevity and the lack of cures for illnesses like cancer and heart disease, palliative care, particularly pain management, has become an important mode OF medical therapy. Palliative care providers feel that “[h]ealth care professionals have a moral duty to provide adequate palliative care and pain relief, even if such care shortens the patient’s life.” Practitioners of forensic medicine grapple with determining when to classify the death of a person formerly receiving palliative care as a non-natural death. Such classification may be paramount in the enforcement of new statutes that aim at preventing assisted suicide or monitoring the quality of health care, but it potentially places forensic medicine and palliative medicine in adversarial roles.

48 Junior doctors and end of life care: a systematic review and narrative synthesis

2018 ◽  
Vol 8 (3) ◽  
pp. 378.1-378
Author(s):  
Aamena Bharmal ◽  
Tessa Morgan ◽  
Stephen Barclay
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Empirical Literature ◽  
Junior Doctors ◽  
List Type ◽  
Narrative Synthesis ◽  
Life Care ◽  
Dying Patients

BackgroundNearly 50% of all deaths in the UK occur in hospitals.1 The majority of these patients die in a generalist setting2 where their medical care is predominately provided by junior doctors. There is a growing recognition of a need to embed palliative care into doctors’ training.3Little evidence exists, however, concerning junior doctors’ current experiences of palliative care.AimsTo review the empirical literature between 2000 and 2018 concerning junior doctors experience of and preparation for palliative and end of life care.MethodsSystematic review and narrative synthesis of qualitative and quantitative studies within six databases to find empirical studies on junior doctors experience of adult palliative care in inpatient hospital or hospice settings.ResultsFrom the initial 6308 titles identified, 32 studies met the inclusion criteria with a further five identified from reference searching.Three key themes were identified:‘Significance of death and dying’‘Thrown into the deep end’‘Addressing the gaps’. All the studies provided evidence that junior doctors care for many dying patients very early in their career. Junior doctors do not feel adequately prepared to care for dying patients and feel unsupported when doing so. Junior doctors report emotional distress when caring for their first few dying patients, memories of which continue to affect them throughout their careers. Their attitudes towards end–of–life care varied: some reported it as a privilege while others associated it with a culture of disengagement that stigmatised dying patients.ConclusionsJunior doctors need further support, education and preparation for their exposure to palliative care. Experiential learning, reflective practice and role modelling are described as the most effective ways to learn palliative care and this also teaches them other transferrable skills such as communication, teamwork and professionalism that are vital for their future careers.References. Office for National Statistics Deaths Registered in England and Wales2016.. Gomes B, Higginson I. Where people die (1974–2030): Past trends, future projections and implications for care. Palliative Med2008;22:33–41.. General Medical Council. Tomorrow’s doctors: Recommendations on undergraduate medical education 2002 (2nd ed.). London: GMC.

scholarly journals Palliative and End-of-Life Care: More Work is Required

2020 ◽  
Vol 17 (20) ◽  
pp. 7429
Author(s):  
Doris Y. P. Leung ◽  
Helen Y. L. Chan
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Empirical Studies ◽  
Life Care ◽  
Care Needs ◽  
Goals Of Medicine ◽  
Palliative Care Education ◽  
Policy Frameworks ◽  
Complex Care Needs

There is currently growing recognition of the complex care needs of patients with life-limiting conditions and their family members, prompting the need to revisit the goals of medicine. This Special Issue reflects a broad research agenda in the field of palliative and end-of-life care. A total of 16 papers of empirical studies and systematic review are included spanning five domains, namely, patient, caregiver, healthcare provider, policy, and methodology. The results generally suggest the merits of palliative care and reveal room for further improvement in palliative care education, manpower, infrastructure, and legal and policy frameworks.

scholarly journals Psychiatry and Terminal Illness

2000 ◽  
Vol 45 (2) ◽  
pp. 143-150 ◽  
Author(s):  
Harvey Max Chochinov
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Health Care Providers ◽  
End Of Life Care ◽  
Terminal Illness ◽  
Empirical Studies ◽  
Life Care ◽  
Care Providers ◽  
Psychological Issues ◽  
Dying Patients

Objective: To provide an overview of the palliative care literature salient to the psychiatric aspect of end-of-life care. Method: A literature review was conducted, targeting primarily empirical studies that addressed the following topics: 1) psychological issues pertaining to life-threatening conditions; 2) family issues in the context of palliative care; 3) psychological issues and challenges faced by end-of-life health care providers; and 4) psychiatric disorders, including depression, anxiety, and organic mental disorders, in people with terminal illness. Results: There is a small but emerging literature that can guide psychiatrists in their role of providing care to dying patients. Conclusions: While psychiatry has made tremendous inroads toward providing care to patients throughout the life cycle, its presence is only just beginning to be felt in end-of-life care. Within the domain of palliative care, psychiatry has an expanded and important role to play.

scholarly journals The Efficacy of Palliative Care Education and Training in Primary Care Settings: A Scoping Review of the Literature

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 446-446
Author(s):  
Jessica Hsieh ◽  
Raza Mirza ◽  
Lynn McDonald ◽  
Christopher Klinger
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Care Service ◽  
Education And Training ◽  
Life Care ◽  
Care Providers ◽  
Palliative Care Education ◽  
And Training

Abstract Primary care providers play an important role in palliative care service provision. A scoping review of the literature was undertaken in an attempt to gain insight into and awareness of palliative education and training needs in primary care settings. Four scientific databases covering the medical and social science fields were searched, alongside Grey literature. A total of 5,109 hits were generated, leading to 2,875 titles for individual review. Of these, 33 articles were included in the final review. Five major themes were identified: (1) communication skills; (2) knowledge of spiritual/psychosocial needs; (3) pain and symptom management; (4) cultural proficiency; and (5) experience working within interdisciplinary teams. Many primary care practitioners felt inadequately trained in palliative care and felt unprepared to provide the necessary care. Specifically, poor communication between healthcare professionals and patients were found to adversely affect the level of palliative care that is provided. Additionally, practical experience in palliative/end-of-life care was cited as one of the most beneficial methods in helping to improve knowledge about and ability to practice in the field. The majority of articles emphasized the need for education and training programs to enhance the quality of palliative/end-of-life care service provision. Palliative care education appeared to have numerous benefits, including enhancing providers’ knowledge of and attitudes towards this subject, ability to provide palliative/end-of-life care, and self-perception of preparedness. As the landscape of education needs are constantly changing, this review serves as one of the steps in an ongoing evaluation of palliative care providers’ training needs.

Five-year retrospective review of end-of-life care quality metrics in a large, multidisciplinary community oncology practice.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 108-108
Author(s):  
Angela Kalisiak ◽  
Elizabeth Ann Gandara ◽  
Susan C Hedlund ◽  
Justin K Gress
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Care Quality ◽  
Life Care ◽  
Code Status ◽  
Palliative Care Education ◽  
Community Oncology ◽  
Advance Care ◽  
Oncology Practice

108 Background: It is increasingly recognized that earlier integration of palliative care for patients with advanced cancers positively impacts both cost and quality of oncology care. Compass Oncology (CO) is a multidisciplinary community oncology practice and a member of The US Oncology Network; 39 medical, gynecologic, and radiation oncologists and 18 advance practice providers serve patients at 6 sites in Oregon and Washington. In 2008, CO prioritized practice improvement in end of life care, identifying metrics for ongoing assessment. Between 2009 and 2014, quality improvement (QI) projects focused on communication skills; whole-staff palliative care education; integration of social workers; initiation of embedded palliative care at 2 sites; and development of a more standardized approach to Advance Care Planning (ACP). Methods: Systematic retrospective record review of patient deaths from January 2009 to December 2013, targeting analysis of hospice utilization, chemotherapy use at end of life, and ACP. Results: Among patients with a CO visit within 6 months of a documented date of death (n= 783 in 2009; n= 909 in 2013), both hospice utilization and ACP participation improved significantly. Percent of patients with evidence for Advance Directive (AD), POLST or code status documented in the electronic medical record (EMR) improved from 36% in 2009 to 50 % in 2013 (p<0.001). Percent of patients enrolled in hospice at the time of death improved from 56% in 2009 to 63% in 2013 (p= 0.003). No statistically significant change was noted in % patients receiving chemotherapy in the last 14 days of life. Conclusions: Focused implementation of end of life care QI strategies in a large multidisciplinary community oncology practice appears to result in both improved hospice utilization and ACP. Chemotherapy usage in the last 14 days of life remains a meaningful target for intervention. Future QI efforts will focus on ongoing, scalable improvement in these metrics. [Table: see text]

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