Preparing future doctors for palliative care

Walker, S. et al. BMJ Supportive & Palliative Care | Published Online: 21 April 2017

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Background: Effective training at medical school is essential to prepare new doctors to safely manage patients with palliative care (PC) and end of life care (EOLC) needs. The contribution of undergraduate PC course organisers is central but their collective views regarding role are unknown.

Objective: To survey attitudes of PC course organisers regarding their course, organisation, the adequacy of training provided and level of personal satisfaction.

Conclusions: Approximately two-thirds of organisers were generally positive about their PC course, institution and role. A minority expressed concerns; these may reflect suboptimal PC training at their medical school and poor preparation of new doctors.

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East Midlands Evaluation Tool for measuring impacts on trainees’ confidence and competence following end of life care training

Whittaker B. et al. BMJ Supportive & Palliative Care. Published Online: 2 February 2017.

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Objectives: To develop, test and validate a versatile questionnaire, the East Midlands Evaluation Tool (EMET), for measuring effects of end of life care training events on trainees’ self-reported confidence and competence.

Conclusions: The EMET provides a time-efficient, reliable and flexible means of evaluating effects of training on self-reported confidence and competence in the key elements of end of life care.

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Distance learning for updating health professionals in palliative care

Taroco Jr., A.L.C et al. BMJ Supportive & Palliative Care. Published Online: 6 January 2017

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Objectives: To review literature regarding online educational initiatives in palliative care which are targeted to update health professionals and prepare distance courses suitable for a Brazilian context.

Conclusions Although the literature is abundant in this area, there is limited research exploring the construction process of courses and how they can be applied to countries with limited resources. It is important to highlight, however, that the mixed teaching strategy, which allows for theoretical and practical activities at a low cost, is imperative for countries with limited resources in healthcare. Thus, this review can support new initiatives around the world, particularly in the low-income and middle-income countries.

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Increasing the number of patients receiving information about transition to end-of-life care

Martinsson, L. et al. (2016) BMJ Supportive & Palliative Care. 6(4) pp. 452-458

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Image source: Rowena Dugdale – Wellcome Images // CC BY-NC-ND 4.0

Introduction: Honest prognostication and information for patients are important parts of end-of-life care. This study examined whether an educational intervention could increase the proportion of patients who received information about the transition to end-of-life (ITEOL care).

Method: Two municipalities (in charge of nursing homes) and two hospitals were randomised to receive an interactive half-day course about ITEOL for physicians and nurses. The proportion of patients who received ITEOL was measured with data from the Swedish Register of Palliative Care (SRPC). Patients were only included if they died an expected death and maintained their ability to express their will until days or hours before their death. Four hospitals and four municipalities were assigned controls, matched by hospital size, population and proportion of patients receiving ITEOL at baseline.

Results:The proportion of patients in the intervention group who received ITEOL increased from 35.1% (during a 6-month period before the intervention) to 42% (during a 6-month period after the intervention). The proportion in the control group increased from 30.4% to 33.7%. The effect of the intervention was significant (p=0.005) in a multivariable model adjusted for time, age, gender and cause of death.

Conclusion: More patients at end-of-life received ITEOL after an educative half-day intervention directed to physicians and nurses.

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Palliative care education for medical students: Differences in course evolution, organisation, evaluation and funding

Walker, S. et al. Palliative Medicine. Published online: October 6, 2016

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Background: A proportion of newly qualified doctors report feeling unprepared to manage patients with palliative care and end-of-life needs. This may be related to barriers within their institution during undergraduate training. Information is limited regarding the current organisation of palliative care teaching across UK medical schools.

Aims: To investigate the evolution and structure of palliative care teaching at UK medical schools.

Design: Anonymised, web-based questionnaire.

Settings/participants: Results were obtained from palliative care course organisers at all 30 UK medical schools.

Results: The palliative care course was established through active planning (13/30, 43%), ad hoc development (10, 33%) or combination of approaches (7, 23%). The place of palliative care teaching within the curriculum varied. A student-selected palliative care component was offered by 29/30 (97%). All medical schools sought student feedback. The course was reviewed in 26/30 (87%) but not in 4. Similarly, a course organiser was responsible for the palliative care programme in 26/30 but not in 4. A total of 22 respondents spent a mean of 3.9 h (median 2.5)/week in supporting/delivering palliative care education (<1–16 h). In all, 17/29 (59%) had attended a teaching course or shared duties with a colleague who had done so. Course organisers received titular recognition in 18/27 (67%; no title 9 (33%); unknown 3 (11%)). An academic department of Palliative Medicine existed in 12/30 (40%) medical schools. Funding was not universally transparent. Palliative care teaching was associated with some form of funding in 20/30 (66%).

Conclusion: Development, organisation, course evaluation and funding for palliative care teaching at UK medical schools are variable. This may have implications for delivery of effective palliative care education for medical students.

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Tailored end-of-life care

In this case study from Leeds Teaching Hospitals NHS Trust,  find out how tailored training has helped staff to gain skills and confidence in:

  • symptom management for patients
  • facilitating end-of-life care at home
  • recognising end of life
  • knowledge of community services

Read previous end-of-life care case studies showing the different approaches that trusts use to deliver training.

Education and training to enhance end-of-life care for nursing home staff

Anstey, S. et al. BMJ Supportive & Palliative Care. Published online 21 June

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Background: The delivery of end-of-life care in nursing homes is challenging. This situation is of concern as 20% of the population die in this setting. Commonly reported reasons include limited access to medical care, inadequate clinical leadership and poor communication between nursing home and medical staff. Education for nursing home staff is suggested as the most important way of overcoming these obstacles.

Objectives: To identify educational interventions to enhance end-of-life care for nursing home staff and to identify types of study designs and outcomes to indicate success and benchmark interventions against recent international guidelines for education for palliative and end-of-life care.

Design: Thirteen databases and reference lists of key journals were searched from the inception of each up to September 2014. Included studies were appraised for quality and data were synthesised thematically.

Results: Twenty-one studies were reviewed. Methodological quality was poor. Education was not of a standard that could be expected to alter clinical behaviour and was evaluated mainly from the perspectives of staff: self-reported increase in knowledge, skills and confidence delivering care rather than direct evidence of impact on clinical practice and patient outcomes. Follow-up was often short term, and despite sound economic arguments for delivering effective end-of-life care to reduce burden on the health service, no economic analyses were reported.

Conclusions: There is a clear and urgent need to design educational interventions that have the potential to improve end-of-life care in nursing homes. Robust evaluation of these interventions should include impact on residents, families and staff and include economic analysis.

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