60. Using a pocket card to improve end-of-life care on clinical teaching units: A controlled trials

2007 ◽  
Vol 30 (4) ◽  
pp. 61
Author(s):  
J. Downar ◽  
J. Mikhael
Keyword(s):  
End Of Life ◽  
Symptom Management ◽  
End Of Life Care ◽  
Palliative Medicine ◽  
Clinical Teaching ◽  
Intervention Group ◽  
Comfort Level ◽  
Control Group ◽  
Life Care ◽  
Comfort Levels

Although palliative and end-of-life is a critical part of in-hospital medical care, residents often have very little formal education in this field. To determine the efficacy of a symptom management pocket card in improving the comfort level and knowledge of residents in delivering end-of-life care on medical clinical teaching units, we performed a controlled trial involving residents on three clinical teaching units. Residents at each site were given a 5-minute questionnaire at the start and at the end of their medicine ward rotation. Measures of self-reported comfort levels were assessed, as were 5 multiple-choice questions reflecting key knowledge areas in end-of-life care. Residents at all three sites were given didactic teaching sessions covering key concepts in palliative and end-of-life care over the course of their medicine ward rotation. Residents at the intervention site were also given a pocket card with information regarding symptom management in end-of-life care. Over 10 months, 137 residents participated on the three clinical teaching units. Comfort levels improved in both control (p < 0.01) and intervention groups (p < 0.01), but the intervention group was significantly more comfortable than the control group at the end of their rotations (z=2.77, p < 0.01). Knowledge was not significantly improved in the control group (p=0.07), but was significantly improved in the intervention group (p < 0.01). The knowledge difference between the two groups approached but did not reach statistical significance at the end of their rotation. In conclusion, our pocket card is a feasible, economical educational intervention that improves resident comfort level and knowledge in delivering end-of-life care on clinical teaching units. Oneschuk D, Moloughney B, Jones-McLean E, Challis A. The Status of Undergraduate Palliative Medicine Education in Canada: a 2001 Survey. Journal Palliative Care 2004; 20:32. Tiernan E, Kearney M, Lynch AM, Holland N, Pyne P. Effectiveness of a teaching programme in pain and symptom management for junior house officers. Support Care Cancer 2001; 9:606-610. Okon TR, Evans JM, Gomez CF, Blackhall LJ. Palliative Educational Outcome with Implementation of PEACE Tool Integrated Clinical Pathway. Journal of Palliative Medicine 2004; 7:279-295.

scholarly journals Cluster-randomised trial of a nurse-led advance care planning session in patients with COPD and their loved ones

Thorax ◽  
2019 ◽  
Vol 74 (4) ◽  
pp. 328-336 ◽  
Author(s):  
Carmen H M Houben ◽  
Martijn A Spruit ◽  
Hans Luyten ◽  
Herman-Jan Pennings ◽  
Vivian E M van den Boogaart ◽  
...  
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Death And Dying ◽  
Intervention Group ◽  
Control Group ◽  
Life Care ◽  
Quality Of Death ◽  
Advance Care

RationaleAdvance care planning (ACP) is uncommon in patients with chronic obstructive pulmonary disease (COPD).ObjectivesTo assess whether a nurse-led ACP-intervention can improve quality of patient-physician end-of-life care communication in patients with COPD. Furthermore, the influence of an ACP-intervention on symptoms of anxiety and depression in patients and loved ones was studied. Finally, quality of death and dying was assessed in patients who died during 2-year follow-up.MethodsA multicentre cluster randomised-controlled trial in patients with advanced COPD was performed. The intervention group received an 1.5 hours structured nurse-led ACP-session. Outcomes were: quality of patient-physician end-of-life care communication, prevalence of ACP-discussions 6 months after baseline, symptoms of anxiety and depression in patients and loved ones and quality of death and dying.Results165 patients were enrolled (89 intervention; 76 control). The improvement of quality of patient-physician end-of-life care communication was significantly higher in the intervention group compared with the control group (p<0.001). The ACP-intervention was significantly associated with the occurrence of an ACP-discussion with physicians within 6 months (p=0.003). At follow-up, symptoms of anxiety were significantly lower in loved ones in the intervention group compared with the control group (p=0.02). Symptoms of anxiety in patients and symptoms of depression in both patients and loved ones were comparable at follow-up (p>0.05). The quality of death and dying was comparable between both groups (p=0.17).ConclusionOne nurse-led ACP-intervention session improves patient-physician end-of-life care communication without causing psychosocial distress in both patients and loved ones.

scholarly journals P135: Canadian emergency medicine residents’ training and competency in end-of-life care: a needs assessment

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S123-S123 ◽  
Author(s):  
C.J. Turner
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Small Groups ◽  
End Of Life Care ◽  
Symptom Control ◽  
Comfort Level ◽  
Formal Training ◽  
Life Care ◽  
Bedside Teaching ◽  
Further Training

Introduction: Emergency Physicians (EPs) face growing numbers of palliative care patients presenting to the emergency department (ED). Formal training for EM residents across Canada in this area is not well described. We sought to describe the training Canadian emergency medicine (EM) residents receive in end of life care issues, their attitudes toward it, self-reported knowledge and skills, and the importance they place on further training in this domain. Methods: We conducted an electronic survey across Canada. We collected demographic data, previous education in palliative care, attitudes toward end of life care, and a self-assessment of competency and desires for further training in the main components of palliative care pertinent to EM. We used simple descriptive statistics, a Mann-Whitney test to assess whether previous formal training in palliative care affected current comfort level, and a combination of self-reported knowledge and importance levels placed on key areas. Results: We received 112 responses from 17 different Universities in Canada, with 42% from the CCFP training stream, and 58% from the FRCP stream. Fifty-four percent of respondents had not completed a palliative care rotation during residency or fellowship, which was overwhelming accounted for by FRCP residents (13%, vs. 82% among CCFPs). Having completed formal training in palliative care was significantly associated with general comfort in managing terminally ill patients (p<0.0001). Sixty percent of subjects felt a lack of knowledge and skills was their main limiting factor in providing ideal care for terminally ill patients in the ED. The skills deemed highest priority with lowest comfort level among residents included discussing withdrawing and withholding care, prognosticating, pharmacology and other symptom control. Preferred methods of receiving palliative care teaching included simulation, bedside teaching and small groups. Conclusion: The care of acute illness among palliative care patients is substantially underrepresented in the Canadian EM curriculum, particularly for FRCP trainees. Formal training is associated with increased comfort in caring for patients at the end of their life. High yield teaching interventions could be directed toward knowledge of withdrawing, prognosticating and symptom control. Simulation, bedside teaching and small groups are the preferred method for receiving such teaching.

scholarly journals Does Death Anxiety Affect End-of-Life Care Discussions?

2014 ◽  
Vol 24 (8) ◽  
pp. 1521-1526 ◽  
Author(s):  
Alaina J. Brown ◽  
Megan J. Shen ◽  
Lois M. Ramondetta ◽  
Diane C. Bodurka ◽  
Robert L. Giuntoli ◽  
...  
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Death Anxiety ◽  
Linear Regression Analysis ◽  
Gynecologic Oncology ◽  
Family Members ◽  
Comfort Level ◽  
Life Care ◽  
Do Not Resuscitate ◽  
Do Not Resuscitate Orders

ObjectivesThe aim of this study was to determine if a gynecologic cancer patient’s comfort level discussing end-of-life care issues with her caregivers is related to her death anxiety level.Materials/MethodsGynecologic oncology clinic patients were asked to rate their degree of agreeability with 4 statements regarding comfort level discussing end-of-life care issues. Participants also completed the Hoge’s Intrinsic Religiosity Scale and Templer’s Death Anxiety Scale.ResultsFour hundred one surveys were distributed. One hundred twenty-nine patients participated, with a response rate of 32.2%. The median age of the sample was 55 years. Most patients were white (72.9%), married (58.9%), and Christian (85.3%). Most patients had ovarian cancer (40.4%). Of the 74 patients who knew their cancer stage, 59% had been diagnosed with advanced (stage III-IV) disease. Thirty-three percent were currently in remission, and 17% had recurrent disease. Of all patients surveyed, 32.6% were currently receiving treatment. Chemotherapy was the most common treatment (62% of those being treated). Higher level of comfort discussing end-of-life care topics such as do-not-resuscitate orders with family members was significantly associated with decreased death anxiety (P = 0.008 and P = 0.001). There was no significant association between comfort level when patients discussed do-not-resuscitate orders with physicians and patients’ death anxiety (P = 0.14). After controlling for age, race, marital status, education level, current treatment status, and religiosity, linear regression analysis demonstrated that the relationship between a patient’s increased comfort level when discussing end-of-life care topics with family members and decreased death anxiety remained statistically significant (P = 0.005 and P = 0.001).ConclusionsConversations regarding goals of treatment are an important component of caring for cancer patients. Death anxiety may contribute to decreased communication between patients and their family members regarding the patient’s end-of-life care wishes. Obtaining a better understanding of the role death anxiety plays in end-of-life care discussions may help patients receive the end-of-life care they desire.

Improving nurse practitioner documentation of QOPI symptom management and end-of-life care measures by using "Smart Text" in electronic health records.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 328-328
Author(s):  
Peg Esper ◽  
Suzette Walker
Keyword(s):  
End Of Life ◽  
Nurse Practitioners ◽  
Symptom Management ◽  
End Of Life Care ◽  
Quality Measures ◽  
Cancer Center ◽  
Life Care ◽  
Chart Audit ◽  
Oncology Patients ◽  
Chart Audits

328 Background: Nurse practitioners (NPs) play a significant role in symptom management, yet the literature is lacking in their role in implementation of quality measures for supportive care, symptom management, and end-of-life care. Previous research, however, has described the importance of oncology NPs in providing palliative care and symptom management. Evidence of ASCO’s Quality Oncology Practice Initiative (QOPI) measures for symptom management and end-of-life care have not been well documented in patient medical records. The objective of this project is to improve NP documentation of these quality measures by incorporating use of “Smart Text” with a new electronic medical record system. The research question is, “Do NPs caring for adult medical oncology patients in the ambulatory care setting demonstrate increased documentation of symptom management quality measures following an educational intervention (EI) as compared to pre-intervention chart audits?” Improved documentation of these measures can positively impact patient outcomes. Methods: This quantitative study utilizes pre- and post-EI chart audits. The pre-intervention chart audit will evaluate 100 charts of oncology patients seen by oncology NPs in an academic cancer center for documentation of symptom management and end-of-life care QOPI measures. Pre-chart analysis will be used to develop the EI. The EI will include development of specific “Smart Text” which include information specific to symptom management and end-of-life care QOPI measures. Following the EI, a post- chart audit will be completed to evaluate improvement in NP documentation of these measures. SPSS software will assist researchers in developing descriptive statistics, graphs and analyses to be used in interpretation of findings. The project has been approved and given exempt status by the institution’s IRB. Results: This study is in process and preliminary results are expected by the time of this meeting taking place. Conclusions: If this intervention proves to be successful, it has the potential to be incorporated by not only nurse practitioners, but by all clinicians in oncology settings across the country.

The pyramid of treatment levels: A tool to convey goal-based treatment options.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 147-147
Author(s):  
Heather Leeper ◽  
Andrew Kamell
Keyword(s):  
Decision Making ◽  
Medical Care ◽  
End Of Life ◽  
Symptom Management ◽  
End Of Life Care ◽  
Life Care ◽  
Care Providers ◽  
Goals Of Care ◽  
Code Status ◽  
Wide Range

147 Background: 60% of Americans die in acute care hospitals and under 40% of advanced cancer patients have end-of-life care discussions with their health care providers. Didactic methods and tools to teach about symptom management, navigation of treatment decisions, code status, and end-of-life care decisions within an inpatient setting are a necessity to meet this high demand. Methods: A model of medical care systematically dividing clinical management decisions into escalating levels of medical care relative to illness severity, treatment goals, and code status was created. The model is illustrated as a pyramid with a base of symptom management as the initial level of medical care. The second level represents disease-focused medical care including antibiotics, disease-modifying drugs, and chemotherapy administration. Hospitalization with increasingly complex and invasive interventions represents the third level followed by critical illness care including ICU admission and vasopressors as the fourth level. Intubation comprises the fifth level and CPR forms the top of the pyramid. Results: This model has been used extensively at our institution in educating medical students, residents, fellows, and faculty. All groups reported it was helpful in understanding POLST forms, code status, and collaboratively developing appropriate goal-based care plans with their patients. Symptom management remaining as a non-negotiable foundation of care emphasizes its importance. This depiction of medical care may facilitate goals of care and code status discussions and is particularly helpful for determining appropriate care goals or options when considering de-escalation of medical therapies. Used implicitly or explicitly in patient and family discussions, it has facilitated decision-making and discerning the appropriateness of the overall treatment plan relative to patient goals of care. Conclusions: This model of care with its companion pyramid accommodate a wide range of clinical scenarios, is an effective, high yield didactic device for patients, families, and healthcare providers alike, and has applications as supportive tool to optimize goal-based clinical decision making in the context of serious illness.

The Impact of Hospice on Mortality of Widowed Spouses (DRAFT)

2018 ◽  
Author(s):  
Kimberson Tanco ◽  
Regina Mackey
Keyword(s):  
Social Support ◽  
End Of Life ◽  
Mortality Risk ◽  
Symptom Management ◽  
End Of Life Care ◽  
Hospice Care ◽  
Family Satisfaction ◽  
Life Care ◽  
Advanced Illness ◽  
The Impact

Caring for a sick spouse can have adverse health consequences and may increase mortality for the surviving spouse. This can be associated to a caregiver and widow/er effect, which may be related to the loss of beneficial social support and impact of stress from the advanced illness and death of the spouse. This study explores if the nature of end-of-life care that the decedent spouse received might be associated with the mortality risk of the surviving spouse. This is preceded by the hypothesis that “good deaths” may result in less stress on the families. At the same time, it is presumed that hospice care facilitates “good deaths” by optimizing symptom management, enables home deaths, and may enhance patient and family satisfaction.

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