This study aimed to analyze the schools that teach ethical and legal aspects within the subject of palliative care in the degrees of medicine and nursing in Spain.
MATERIAL AND METHODS: Descriptive Analysis of the palliative care subject and their ethical and legal curricular competencies in the Spanish Nursing and Physicians undergraduate. The training received in legal ethical aspects related to palliative care was compared with the criteria established by the European Association for Palliative Care (EAPC).
DATA SOURCES: The National Conference of Nursing Deans, The National Conference of Spanish Medical Faculty Deans and The Ministry of Science, Innovation, and Universities databases were searched.
RESULTS: Twenty-one universities have an undergraduate in medicine with palliative care in their curricular training explicitly. The degree in nursing is present in fifty-six universities, palliative care is present in 62.5% of the cases. The degrees of nursing and medicine receive approximately the same level of training in ethical and legal aspects of palliative care.
CONCLUSION: The specific training received in ethical and legal issues of palliative care must be improved in medical and nursing to meet the EAPC levels.
CONTEXT: The coronavirus disease 2019 (COVID-19) pandemic is stressing health care systems throughout the world. Significant numbers of patients are being admitted to the hospital with severe illness, often in the setting of advanced age and underlying comorbidities. Therefore, palliative care is an important part of the response to this pandemic. The Seattle area and UW Medicine have been on the forefront of the pandemic in the U.S.
METHODS: UW Medicine developed a strategy to implement a palliative care response for a multihospital health care system that incorporates conventional capacity, contingency capacity, and crisis capacity. The strategy was developed by our palliative care programs with input from the health care system leadership.
RESULTS: In this publication, we share our multifaceted strategy to implement high-quality palliative care in the context of the COVID-19 pandemic that incorporates conventional, contingency, and crisis capacity and focuses on the areas of the hospital caring for the most patients: the emergency department, intensive care units, and acute care services. The strategy focuses on key content areas, including identifying and addressing goals of care, addressing moderate and severe symptoms, and supporting family members.
CONCLUSION: Strategy planning for delivery of high-quality palliative care in the context of the COVID-19 pandemic represents an important area of need for our health care systems. We share our experiences of developing such a strategy to help other institutions conduct and adapt such strategies more quickly.
Previous literature demonstrates that current palliative care training is in need of improvement for medical students in global, European and Canadian contexts. The training of medical undergraduates is key to ensure that the ongoing and increasing need for enhanced access to palliative care across all settings and communities is met. We describe building a comprehensive palliative and end-of-life care curriculum for medical undergraduates at our university. As with recent European and US studies, we found that the process of university curriculum renewal provided a critical opportunity to integrate palliative care content, but needed a local palliative care champion already in place as an energetic and tireless advocate. The development and integration of a substantive bilingual (English and French) palliative and end-of-life care curriculum over the 4-year medical undergraduate program at our university has occurred over the course of 14 years, and required multiple steps and initiatives. Subsequent to the development of the curriculum, there has been a 13-fold increase in students selecting our palliative care clinical rotations. Critical lessons learned speak to the importance of having a team vision, interprofessional collaboration with a focus on vision, plans and implementation, and flexibility to actively respond and further integrate new educational opportunities within the curriculum. Future directions for our palliative care curriculum include shifting to a competency-based training and evaluation paradigm. Our findings and lessons learned may help others who are working to develop a comprehensive undergraduate medical education curriculum.
Death metaphors are a meaningful way to understand personal perceptions of death, an important construct affecting how people live. This study collected death metaphor data among 100 university students in Hong Kong in 2016 and compared the findings with another study reported in 2004. Interpersonally oriented death metaphors were still popular among students a decade later. There was a general decrease in positive perception of death and an increase in negative perception of death from 2004 to 2016. Death metaphors are useful tools in death education programs, especially in cultures where death is a taboo topic.
This study examines the experiences and beliefs of university students which affect attitudes toward palliative care. A total of 322 students responded to a survey on palliative care and end-of-life attitudes. Almost 40% of the students reported not having enough knowledge about options at the end of life. Results of multiple regression indicate students who have more negative attitudes toward palliative care did not believe in end-of-life care planning. Female students and those who had a family member or friend who used palliative care had more positive attitudes toward palliative care. Understanding student perceptions of palliative care allows for developing curriculum sensitive to learners' needs and addressing misconceptions.
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.
METHODS: An anonymised, multifactorial, web-based questionnaire was devised, tested, modified and then sent to lead PC course organisers at all UK medical schools.
RESULTS: Data were obtained from all 30 UK medical schools. Organisers agreed/strongly agreed (=agreed) that their PC course was highly rated by students (26, 87%). 25 (83%) agreed their course 'enabled misconceptions and fears about PC, death, dying and bereavement to be addressed', 'delivered quality PC training' (23, 77%), 'fulfilled General Medical Council requirements' (19, 63%), 'prepared students well to care for patients with PC/EOLC needs' (18, 60%) and 'enabled students to visit a hospice and see the role of doctors in caring for the dying' (17, 57%). Concerns were limited capacity to accommodate students (agreed 20, 66%) and variability in teaching according to location (15, 50%). Most agreed their institution recognised PC training as important (22, 73%), they felt supported by colleagues (21, 70%) and experienced cooperation between stakeholders (20, 67%). All agreed that PC training was essential for undergraduates, while 29 (97%) supported inclusion of a hospice visit in the curriculum. 27 agreed that their role was satisfying (90%), 3 disagreed (10%).
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.
OBJECTIVES: Generation and dissemination of knowledge is a relevant challenge of palliative care (PC). The Chair Catalan Institute of Oncology (ICO)/University of Vic (UVIC) of Palliative Care (CPC) was founded in 2012, as a joint project of the ICO and the University of Vic/Central of Catalonia to promote the development of PC with public health and community-oriented vision and academic perspectives. The initiative brought together professionals from a wide range of disciplines (PC, geriatrics, oncology, primary care and policy) and became the first chair of PC in Spain. We describe the experience of the CPC at its fifth year of implementation.
METHODS: Data collection from annual reports, publications, training and research activities.
RESULTS: Results for period 2012-2017 are classified into three main blocks: (1) Programme: (a) The advanced chronic care model (Palliative needs (NECPAL)); (b) the psychosocial and spiritual domains of care (Psychosocial needs (PSICPAL)); (c) advance care planning and shared decision making (Advance care planning (PDAPAL)); and (d) the compassive communities projects (Society involvement (SOCPAL)). (2) Education and training activities: (a) The master of PC, 13 editions and 550 professionals trained; (b) postgraduate course on psychosocial care, 4 editions and 140 professionals trained; and (c) workshops on specific topics, pregraduate training and online activities with a remarkable impact on the Spanish-speaking community. (3) Knowledge-transfer activities and research projects: (a) Development of 20 PhDs projects; and (b) 59 articles and 6 books published.
CONCLUSION: Being the first initiative of chair in PC in Spain, the CPC has provided a framework of multidisciplinary areas that have generated innovative experiences and projects in PC.
This article reports on a small, qualitative, in-house pilot case study on student bereavement support at one UK university, where I work. The study’s aim was to examine how bereaved students are supported to continue their studies and recover their emotional well-being from the perspectives of both previously bereaved students and staff involved in dealing with student bereavement.
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Student deaths on college campuses, whether brought about by a suicide or an uncontrollable incident, have serious repercussions for the mental wellbeing of students. Consequently, many campus administrators implement post-crisis intervention measures to promote student-centric mental health support. Information about these measures, which we refer to as "counseling recommendations", are often shared via electronic channels, including social media. However, the current ability to assess the effects of these recommendations on post-crisis psychological states is limited. We propose a causal analysis framework to examine the effects of these counseling recommendations after student deaths. We leverage a dataset from 174 Reddit campus communities and ~400M posts of ~350K users. Then we employ statistical modeling and natural language analysis to quantify the psychosocial shifts in behavioral, cognitive, and affective expression of grief in individuals who are "exposed" to (comment on) the counseling recommendations, compared to that in a matched control cohort. Drawing on crisis and psychology research, we find that the exposed individuals show greater grief, psycholinguistic, and social expressiveness, providing evidence of a healing response to crisis and thereby positive psychological effects of the counseling recommendations. We discuss the implications of our work in supporting post-crisis rehabilitation and intervention efforts on college campuses.
The purpose of the current study was to examine the association between prolonged grief disorder, perceived social support, and severity of depression among Saudi Arabian university students after the death of a significant individual. A cross-sectional design was used to examine descriptive characteristics, correlational relationships, and statistical mean differences between male and female participants on prolonged grief disorder (PGD) scores in a convenience sample of Saudi Arabian college students. The Prolonged Grief Disorder-13 tool, Multidimensional Scale of Perceived Social Support, and the revised Beck Depression Inventory® were completed by 226 Saudi Arabian undergraduate students. Students reported moderate perceived social support from family, friends, and significant others. Only 13 (5.8%) individuals reported perceived support from academic staff. Students with the highest PGD scores were the least well-supported and most depressed. The need for academic staff and social workers to provide more social support to grieving students is discussed. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.].
The present investigation sought to explore the difference in death anxiety between two different samples of students who studied at the same university in Lebanon in 1998 and 2015. Based on the changes in the social, economic, and political conditions that took place over these 17 years, it is possible to predict the change in death anxiety during this period. The participants in the 1998 study included 228 undergraduates, whereas the 2015 sample consisted of 292 students. All participants responded to Templer’s Death Anxiety Scale (DAS). Sex-related differences on the DAS were statistically significant in the 1998 group where women obtained a higher mean than the men. The t-test was significant at 0.001. Among women, the 2015 group obtained a significantly lower mean score than did their female counterparts in the 1998 group, whereas the difference between the two years in men was not significant. In sum, the hypothesis of the study was partially verified, i.e., a change in death anxiety level in some groups has happened as a result of the passage of time and other factors. In this case, death anxiety may be considered a fluid entity influenced by different environmental conditions.
This workshop details a Partnership involving a High school, a Hospital (Calvary Health Care Bethlehem), La Trobe University and Palliative Care Victoria which seeks to support Community Capacity and resilience in dealing with Life-Limiting illness, death, dying and Loss. This alliance has produced an educational resource which may be used, not only as a tool to normalize death, but also as a means of exploring 'keys to well-being' at any stage of life, through any loss or challenge. This workshop features a template which has been trialled, adapted and evaluated in High School, workshop and Hospital induction settings within Australia. Responses thus far have been "overwhelmingly positive". Translating evidence of positive outcomes into Education & Health Care Systems, is a challenge-this workshop offers a means of approaching both. The conclusion of the workshop provides a number of insights: (I) engaging communities in discussions about well-being and harnessing the insights of youth is a palatable means of discussing well-being at end-of-life; (II) what we know, as a community about supporting people with life-limiting illness is applicable across the span of life-not just at the end; (III) just as it takes a village to raise a child-it takes a village to ensure a quality end-of life experience. What began as a one-off hospital immersion for Secondary School students has grown to become a sustainable educational resource, applicable across a number of domains-with the capacity to become an evidence-based means of increasing community EOL capacity. This workshop details the evolution of a community partnership, which produced an evaluated, sustainable, educational resource encouraging conversations about death and loss whilst emphasizing the essentials of well-being. It is a potential "foot in the door" of the education system and an "ice-breaker" for new staff/students to Palliative care.
BACKGROUND: A program of Compassionate City or Community (CC) has been designed and developed in the City of Vic (43,964 habitants, Barcelona, Spain), based on The Compassionate City Charter and other public health literature and experiments, with the joint leadership of the City Council and the Chair of Palliative Care at the University of Vic, and as an expansion of a comprehensive and integrated system of palliative care.
METHODS: The program started with an assessment of needs of the city as identified by 48 social organizations with a foundational workshop and a semi-structured survey. After this assessment, the mission, vision, values and aims were agreed. The main aims consisted in promoting changes in social and cultural attitudes toward the end of life (EoL) and providing integrated care for people with advanced chronic conditions and social needs such as loneliness, poverty, low access to services at home, or conflict. The selected slogan was "Living with meaning, dignity, and support the end of life".
RESULTS: The program for the first year has included 19 activities (cultural, training, informative, and mixed) and followed by 1,260 attendants, and the training activities were followed by 147 people. Local and regional sponsors are funding the initiative. After a year, a quantitative and qualitative evaluation was performed, showing high participation and satisfaction of the attendants and organizations. In the second year, the care for particular vulnerable people defined as targets (EoL and social factors described before) will start with volunteers with more organizations to join the project.
CONCLUSIONS: The key identified factors for the initial success are: the strong joint leadership between social department of the Council and the University; clear aims and targets; high participation rates; the limited size of the geographical context; which allowed high participation and recognition; and the commitment to evaluate results.
BACKGROUND: In Europe in recent decades, university teaching of palliative medicine (PM) has evolved. In some countries it has been introduced as a compulsory subject in all medical schools, but in a majority of countries it remains an isolated subject at few universities.
OBJECTIVE: To explore how PM has been introduced into the curricula and how it is currently being taught at different European universities.
METHOD: Case study method using face-to-face semistructured interviews with experienced PM professors, comparing how they have developed PM undergraduate programs at their universities.
RESULTS: An intentional sample of eight university professors from Spain, France, UK, Italy, Hungary, Sweden, Germany, and Poland was chosen. The introduction of PM in the universities depends on the existence of a favorable social and political context in relation to palliative care and the initiative of pioneers, trusted by students, to push this education forward. A PM curriculum frequently starts as an optional subject and becomes mandatory in a short period. In the reported universities, PM uses a wide variety of teaching methods, such as lectures, workshops, role-plays, and discussions. PM assessment included tests, discussions, reflections, portfolios, and research works. According to respondents' opinions, lack of recognition, funding, and accredited teachers, along with competition from other curricula, are the main barriers for palliative medicine teaching development at universities.
CONCLUSION: Diverse paths and tools have been identified for PM teaching in Europe. The described cases may shed light on other medical schools to develop PM curricula.
The impact of interpersonal violence extends beyond the victims and perpetrator(s). The purpose of this research was threefold: (a) to identify whether college students' very early reactions to an on-campus shooting were associated with well-known predictors of distress, (b) to examine whether grief and distress reactions were distinguishable in the early days following a shooting, and (c) to investigate whether a compassionate self-identity was uniquely associated with grief but not distress. Beginning just 3 days after an early morning shooting that killed one student and injured three others, university students ( N = 408) completed an online questionnaire. Grief, but not distress, was associated with a sense of solidarity with other students and a compassionate self-identity. General distress was associated with prior mental health difficulties and exposure to the shooting. Acute stress was positively associated with being female, having prior mental health difficulties, media exposure, perceived similarity to victims, less victim blame, social support, and social strain. Results suggest that grief reactions that arise in the early days following a collective loss may serve as important psychosocial resources in coping with interpersonal violence.
This study identifies risk factors for grief following a mass school shooting. Participants (N = 1,013) completed online questionnaires 3-4 months (Time 1) and 1 year (Time 2) post-shootings. We tested models predicting Time 2 grief reactions, exploring direct and indirect predictive effects of exposure variables (physical and social proximity) through hypothesized peritraumatic mediators (peritraumatic perceived threat to self or others) while controlling for Time 1 grief and posttraumatic stress (PTS) reactions, pretrauma vulnerabilities. Findings demonstrate that closer social proximity predicted higher levels of Time 2 grief, directly and indirectly through increasing peritraumatic perceived threat to others' safety. Physical proximity and peritraumatic threat to self did not predict Time 2 grief reactions. Implications for grief screening instruments and theory building research through identifying risk factors and causal mechanisms are discussed.
Using data collected from a questionnaire survey of 501 university students in a western Canadian city, this article explores the death anxiety among young adults and the factors influencing their levels of death anxiety. Results demonstrated that respondents displayed a moderate level of death anxiety. Multiple regression analysis further revealed that females, non-Caucasians and those who demonstrated to be less religious, indicated a higher level of loneliness, scored lower on the purpose in life scale, expressed dissatisfaction with their self-image, and reported a higher socio-economic status were found to exhibit a higher level of death anxiety.
Ce numéro thématique regroupe les articles suivants : dignité de la relation de soin ; un centre interdisciplinaire d'éthique à l'université catholique de Lyon ; la dignité de la personne humaine et la relation de soin ; dignité et personne âgée ; la dignité en institution de retraite ; la dépendance du grand-âge : résonance familiale ; la dignité : un mot porteur de sens ; quelle souffrance et quelle dignité ? ; comment garder son sentiment de dignité malgré une grande dépendance.