Palliative care is central to the role of all clinical doctors. There is variability in the amount and type of teaching about palliative care at undergraduate level. Time allocated for such teaching within the undergraduate medical curricula remains scarce. Given this, the effectiveness of palliative care teaching needs to be known.
OBJECTIVES: To evaluate the effectiveness of palliative care teaching for undergraduate medical students.
DESIGN: A systematic review was prepared according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. Screening, data extraction and quality assessment (mixed methods and Cochrane risk of bias tool) were performed in duplicate.
DATA SOURCES: Embase, MEDLINE, PsycINFO, Web of Science, ClinicalTrials.gov, Cochrane and grey literature in August 2019. Studies evaluating palliative care teaching interventions with medical students were included.
RESULTS: 1446 titles/abstracts and 122 full-text articles were screened. 19 studies were included with 3253 participants. 17 of the varied methods palliative care teaching interventions improved knowledge outcomes. The effect of teaching on clinical practice and patient outcomes was not evaluated in any study.
CONCLUSIONS: The majority of palliative care teaching interventions reviewed improved knowledge of medical students. The studies did not show one type of teaching method to be better than others, and thus no 'best way' to provide teaching about palliative care was identified. High quality, comparative research is needed to further understand effectiveness of palliative care teaching on patient care/clinical practice/outcomes in the short-term and longer-term.
Les soins palliatifs demandent de plus en plus de compétences médicales, soignantes, humaines et éthiques, afin d’asseoir leur légitimité dans des domaines de plus en plus pointus de la médecine – réanimation, néonatalogie, cancérologie, gériatrie – ainsi que dans la diversité des prises en charge, y compris au domicile ou en EPHAD.
Dans ce contexte de développement des formations et d’élargissement des champs de compétences de la pratique palliative, cette 5e édition du manuel offre :
-les indispensables connaissances thérapeutiques ;
-les outils, à destination des professionnels en vue d’acquérir une compétence clinique pour la rencontre et l’accompagnement humain, psychique et relationnelle de la personne malade ;
-une contextualisation de la pratique des soins palliatifs dans leur dimension sociale, sanitaire et politique ;
-des jalons pédagogiques pour le développement des soins palliatifs dans leur dimension pédagogique et de recherche.
"Kipal, le jeu du qui quoi comment en soins palliatifs" est un outil ludopédagogique élaboré par une infirmière et un médecin membres d’une équipe mobile de soins palliatifs au centre hospitalier de Vienne. Grâce à la création de cas patients fictifs et évolutifs au cours du jeu, les soignants participants peuvent appréhender des thèmes variés concernant les soins palliatifs de façon interactive. Les bénéfices attendus sont, une implication des apprenants devenant acteurs de leur formation, la dédramatisation du thème des soins palliatifs, la définition d’une démarche palliative et la découverte de la variété des prises en soin par la richesse des scénarios possibles. Pour cela, le jeu propose 16 situations cliniques brèves, issues de diverses spécialités, 46 cartes dites "évènement" (clinique, psychologique, social ou familial) et 62 cartes "suggestion" (ressources humaines et techniques disponibles) qui pourront être associées à l’infini à chaque partie. Cet outil est réservé aux professionnels des soins palliatifs lors de formations destinées à des soignants non spécialisés, mais exerçant auprès de personnes nécessitant des soins palliatifs. En perspective, des extensions pourront être développées pour s’adapter à un public plus large (pédiatrie, domicile). Soutenu par le Fonds pour les soins palliatifs et approuvé par la Société française d’accompagnement et de soins palliatifs (SFAP), 250 jeux Kipal ont été attribués lors du congrès francophone de soins palliatifs organisé par la SFAP et la Fédération francophone internationale de soins palliatifs en 2019.
As the population ages, the number of careers that intersect with aging is expected to grow. However, many young people lack an interest in working with aging populations. As previous work has shown, though, students' interest in aging careers may be stimulated by coursework and experiential activities related to aging. Despite being a normative developmental process, anxiety about death and dying may be particular barriers to students developing interest in aging, and these topics may be particularly difficult subjects to teach in the college classroom. Here, strategies and activities for teaching the end of life are offered.
Objective: To describe museum-based education (MBE) as an emerging pedagogy in our four hospice and palliative medicine (HPM) training programs.
Background: MBE is a pedagogy that uses art and the museum space to promote a variety of skills, including reflective practice, self-awareness, and interprofessional teamwork. While MBE has been extensively applied and studied in undergraduate medical education, it is not a common educational strategy in HPM education.
Methods: We summarize the characteristics of MBE initiatives in our institutions, including makeup of fellowship class, MBE site, facilitators, exercises, number of sessions, number of years using MBE, and expenses and funding to support MBE in our training programs.
Results: To date, we have used MBE to train 104 HPM fellows. Evaluations from MBE have been overwhelmingly positive.
Conclusion: MBE holds great promise as a pedagogic strategy to improve metacognition, tolerance of uncertainty, appreciation of multiple perspectives, and teamwork among hospice and palliative care professionals. Further research is needed to identify best practices for MBE across HPM training programs.
Nursing education programs and nursing textbooks often present accounts of the work of Dr Elisabeth Kübler-Ross and her “5 stages” model. In this article, we examine a sampling of recent North American nursing textbooks to illustrate the different ways those subjects are discussed. Unfortunately, the information provided is not always accurate or helpful in guiding readers. We describe why that is so and suggest some ways in which better guidance could be delivered. It is particularly timely to undertake this examination since 2019 is the 50th anniversary of the publication of On Death and Dying, the well-known book in which Dr Kübler-Ross first published her theory and descriptions of the work that led to it.
Palliative care education at the undergraduate and graduate level is necessary to improve the competency and confidence of nurses and ultimately improve the care of patients with a chronic illness. Unfortunately, the curriculum in nursing education programs lacks palliative care content, resulting in a lack of preparation and confidence among nursing students. The purpose of this study is to examine the effect of educating nursing students utilizing an interactive, multimodality palliative care class that focuses on palliative and end-of-life care. The Palliative Care Quiz for Nurses and Frommelt Attitude Toward Care of the Dying survey were used to assess nursing students before and after a newly developed palliative care class. A Wilcoxon matched-pairs signed rank test was used to determine a difference in pre and post scores. Results revealed a significant improvement in knowledge, attitude, and comfort with palliative and end-of-life care.
Nurses play an essential role in providing compassionate evidence-based care at the end of life, yet many undergraduate students have limited opportunities to participate in end-of-life care experiences. Arts-based pedagogy has been explored as a strategy in nursing education that focuses on the affective domain of learning. The purpose of this qualitative narrative analysis was to explore the impact of an arts-based reflection assignment on student affective learning using artistic images depicting end-of-life scenarios. Student written narratives (n = 21) were analyzed using content analysis, and four themes emerged that described the components of affective learning in several areas.
Death and dying are two core aspects of medicine that we feel are often neglected at medical school. Here, we present our views on end-of-life teaching thus far, and our opinions on how the medical school curriculum could be improved.
Les codes sous-jacents de la démarche palliative, d’une part, et du management, d’autre part, pourraient paraître antinomiques. Pourtant, l’exercice des managers au sein d’un établissement de santé ou du médico-social est censé côtoyer les principes du care comme mode relationnel avec ses employés. Cet article retrace la genèse de ce questionnement né de la sollicitation d’enseigner les soins palliatifs à des futurs directeurs. En effet, la pratique pédagogique nous a amenés à considérer les soins palliatifs non seulement comme un contenu d’enseignement, mais comme un potentiel modèle managérial intégrant à la fois une vision de co-construction des projets, une implication à tous les niveaux des professionnels, l’empathie dans la relation et la prise en compte de l’impossible.
L'universitarisation de la formation infirmière engagée depuis 2009 vise la professionnalisation des futurs professionnels de santé dans un environnement hospitalier mouvant. Cette approche fondée sur les compétences, la réflexivité et l'agentivité de l'étudiant nécessite un accompagnement pédagogique individualisé. L'accompagnement pédagogique est au coeur des relations entre le cadre de santé formateur et l'étudiant infirmier.
Ce travail de recherche questionne l'impact de l'accompagnement pédagogique sur l'agentivité de l'étudiant au service de sa professionnalisation. Afin de confronter nos hypothèses mettant en évidence l'intérêt de l'agentivité et de l'auto-efficacité dans la formation à la réalité, nous avons rencontré des étudiants en soins infirmiers en milieu de formation. Qui de plus au fait de leur vécu de formation et de leur apprentissage que les étudiants eux-mêmes ?
Les situations de soins palliatifs ou de fin de vie peuvent être difficiles à gérer pour les étudiants en soins infirmiers.
L'évolution de la formation infirmière a permis la mise en place d'enseignements de soins palliatifs et des moyens d'accompagner les étudiants dans leur apprentissage de ces situations.
Le suivi pédagogique des étudiants et l'analyse de pratiques professionnelles pourraient être des moyens de gérer les situations de soins palliatifs et de fin de vie, en développant la pratique réflexive et les compétences des futurs professionnels.
Des étudiants ont participé à cette recherche, les résultats ont permis d'ouvrir la réflexion et d'élargir l'hypothèse.
La professionnalisation en serait-elle la clé ?
The objective of this mixed methods study was to evaluate the feasibility and acceptability of using a virtual world educational environment for interprofessional health professions students learning about palliative care. Graduate students (n = 35) from five different health professions programs (medicine, nursing, nutrition, physical therapy, and social work) across two educational institutions participated in a small-group immersive educational experience focused on palliative care in the virtual world of Second Life. Collected data included pre and post surveys of interprofessional attitudes using previously-published questionnaires as well as student reflective writing and photographs about their experience. We found it was feasible to create and deliver an interprofessional educational experience in palliative care in a virtual world environment. The educational experience was acceptable to participants, with an improvement in attitudes toward interprofessional education and interprofessional teamwork after a single virtual world educational session, based on both quantitative and qualitative results. Students found the virtual world environment acceptable for interprofessional education focused on palliative care, based on qualitative results. As health professions schools develop interprofessional education curricula, the use of virtual world technology may be an important modality to consider, to effectively and conveniently bring interprofessional learners together.
Background: Advance care planning (ACP) is a critical component of end-of-life (EoL) care, yet infrequently taught in medical training.
Objective: We designed a novel curriculum that affords third-year medical students (MS3s) the opportunity to practice EoL care discussions with a trained older adult in the patient's home.
Design: Volunteers were instructed as trained patients (TPs) to evaluate MS3s interviewing and communication skills. The MS3s received a didactic lecture and supplemental material about ACP. Pairs of MS3s conducted ACP interviews with TPs who gave verbal and written feedback to students. Student evaluations included reflective essays and pre/postsurveys in ACP skills.
Settings and Participants: A total of 223 US MS3s participated in the curriculum.
Results: Qualitative analysis of reflective essays revealed 4 themes: (1) students' personal feelings, attitudes, and observations about conducting ACP interviews; (2) observations about the process of relationship building; (3) learning about and respecting patients' values and choices; and (4) the importance of practicing the ACP skills in medical school. Students' confidence in skills significantly improved in all 7 domains (P < .001): (1) introduce subject of EoL; (2) define advance directives; (3) assess values, goals, and priorities; (4) discuss prior experience with death; (5) assess expectations about treatment and hospitalization; (6) explain cardiopulmonary resuscitation and outcomes; and (7) deal with own feelings about EoL and providers' limitations.
Conclusions: The use of older adults as TPs in an ACP curriculum provides students an opportunity to practice skills and receive feedback in the nonmedical setting, thereby improving comfort and confidence in approaching these conversations for future patients.
Nurse educators have a unique role to prepare nursing students for all aspects of patient and family care, from birth through death. Knowing that death is inevitable is not the challenge. Preparing nursing students to cope with death and address personal and community myths about death and dying are the challenges. Opportunities for students to examine personal and community associations with death are essential for nursing students preparing to enter the field. Biophysiological processes and treatment protocols are an essential part of each course; however, one course in a Department of Nursing in a small university in the Midwestern United States provides students the opportunity to reflect on death and dying and includes the experience of creating a tangible symbol to “hold on to” as they professionally and thoughtfully work with dying patients and their families, as well as cope with their own experiences of loss and grief in their careers.
Background: Learning palliative care is challenging for nursing students. Simulation is recommended as a learning approach. Whether experiences from simulation transfer into clinical practice must be investigated.
Objective: The aim of this study was to explore nursing students' experiences of participating in palliative care simulation and examine how they describe the perceived transfer of knowledge, skills, and competence into clinical practise.
Method: This prospective, qualitative study was comprised of 11 in-depth interviews with second-year bachelor nursing students. Content analysis was performed to analyse the answers to open-ended questions.
Results: From this sample, simulation is a preferred method to gather knowledge, skills, and attitudes towards palliative care. Realistic cases stimulated senses and feelings. Courage grew through active participation and debriefing and influenced the students' self-confidence. Debriefing seemed to alter the situation from one of chaos to control.
Conclusions: Experiences from the simulation were perceived to transfer to practice, serve as a sound basis for clinical judgement, and enable communication with patients and their relatives. Continuity in learning through simulation combined with practice is highlighted.
BACKGROUND: This article outlines the rationale of developing a DVD using a simulated patient to show students how to perform the last offices in the UK and what they can expect when a patient dies.
AIM: This is an aspect of the curriculum that students felt was not adequately covered and they were anxious about experiencing the death of a patient for the first time. The DVD allowed a large number of students to receive extra teaching on this topic and was a time-effective way of introducing more teaching into the curriculum.
CONCLUSION: Students felt more prepared for the death of a patient during their first clinical placement.
Background: Nursing students have limited opportunities to experience end-of-life care, so it is difficult for them to learn how to deliver it empirically. The use of simulations with standardized patients may be a way to provide realistic experience of end-of-life care for nursing students.
Objectives: The aim of this study was to evaluate the effectiveness of end-of-life care simulations with standardized patients in improving the knowledge, skill performance and self-confidence of undergraduate nursing students.
Design: Randomized controlled study.
Setting: Japanese university nursing school.
Participants: Thirty-eight students in the third year of the Bachelor's degree in nursing (simulation group = 20, control group = 18).
Methods: After randomization to a simulation or control group, participants in the simulation group participated in an end-of-life care simulation with standardized patients. The primary outcome of a change in the knowledge score was assessed using a knowledge questionnaire, skill performance by completing Objective Structured Clinical Evaluations, and self-confidence related to end-of-life care by self-reported questionnaires.
Results: The simulation group improved significantly in knowledge, skill performance in physical assessment and psychological care, and self-confidence related to end-of-life care. The results of the two-way analysis of variance showed a significant interaction between groups and time (p = 0.000). Analysis of the simple main effect showed a significant difference (p = 0.000) between groups after the end-of-life care simulation and a significant difference (p = 0.000) over time in the simulation group. There were large effects on knowledge improvement ( 2 = 0.372), physical assessment ( 2 = 0.619), psychological care skill performance ( 2 = 0.588), and self-confidence in both physical assessment ( 2 = 0.410) and psychological care ( 2 = 0.722).
Conclusions: End-of-life care simulation with standardized patients would be an effective strategy to train nursing students, who have limited opportunities to experience end-of-life
Background: Opportunities to provide competent and compassionate End-of Life (EOL) care to patients and families are limited for nursing students.
Method: A mixed methods approach was used to explore the students' attitudes towards caring for an EOL patient in two groups: an on-line-module only group and an on-line module plus simulation group.
Results: :Statistically significant effect of time was found across the two conditions (F [1, 69] = 7.83, p = .007), indicating that scores on the FATCOD-B significantly improved regardless of the condition over time. The qualitative responses indicated that the simulation experience was more impactful than the on-line module.
Conclusions: Innovative education modalities described in the study may assist in preparing the future workforce for the myriad of demands related to health, life, and death.
Evidence suggests that patients with a prognosis less than one year are burdened by polypharmacy and take an average of 11.5 medications per day. Deprescribing is the process to tapering or stopping drugs, aimed at improving patient outcomes near the end of life by minimizing polypharmacy (see Fast Fact #321). Barriers to deprescribing include a lack of clinician confidence in deprescribing skills and a fear of triggering psychological distress from the patient by discountinuing familiar medications. Research indicates that, fortunately, patient-clinician trust can endure when deprescribing is done well. This Fast Fact offers a deprescribing communication framework for leading these conversations.