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To incorporate a longitudinal palliative care curriculum into obstetrics and gynecology (Ob-Gyn) residency that could become standardized to ensure competencies in providing end of life (EOL) care.
Methods
This was a prospective cohort study conducted among 23 Ob-Gyn residents at a tertiary training hospital from 2021 to 2022. A curriculum intervention was provided via lecture and simulation. An inpatient palliative care rotation was also created for the intern class. Scores for knowledge and confidence were compared pre- and post-curriculum. Performance on patient simulations was compared for interns who had the inpatient palliative rotation versus those that had not in a crossover fashion. Number of palliative care consults was also compared before and during the curriculum. A pooled, weighted rank-based test was used for analysis of the data with a p-value < 0.05 considered significant.
Results
One hundred percent of the 23 eligible participants participated in this study. A statistically significant increase in scores on all quizzes (p-values 0.047, <0.001, and <0.001) and confidence surveys (composite score p-value < 0.001) was seen after curriculum completion. No statistically significant difference was able to be identified in standardized patient simulation performance. Palliative care consultation increased by 55%.
Significance of results
EOL care is a critical component of any physician’s practice including obstetrician gynecologists. However, prior studies demonstrate a lack of standardized training. Our study demonstrates that a multimodal palliative care curriculum is an effective method to train Ob-Gyn residents and improve palliative care involvement in patient care.
To describe the development and implementation of a novel tool designed to enhance nurse–patient communication in a major academic cancer center, which nurses can learn quickly, incorporate into their primary palliative care practice, and broadly disseminate in order to improve the patient experience.
Method
An evidence-based empathic communication tool and educational program were designed to provide essential skills to oncology nurses in having discussions with patients about their personal values. Evaluation included nurse focus groups, pre- and post-course evaluations and interviews, and patient questionnaires.
Results
Nurses were satisfied with the educational program and found the communication tool effective in a variety of clinical situations including discussions about personal values. Patients reported increased occurrences of these discussions when nurses utilized the framework (97% vs. 58%, p < 0.0001) and a higher quality of clinician communication (mean [SD] from 0 = very worst to 10 = very best: 7.18 [2.3] vs. 5.04 [2.9], p = 0.001).
Significance of results
Skilled, empathic communication is an essential component of high-quality primary palliative care. Oncology nurses are well suited to lead communication and provide this care as part of an interprofessional team. The training and tool described here are targeted and efficient, and prepare nurses to respond skillfully to emotion while facilitating important discussions about patient values.
Palliative care requires nurses to be knowledgeable about different aspects of the care that they provide for dying patients. This study, therefore, was conducted to examine oncology and intensive care nurses' knowledge about palliative care in Southeast Iran.
Method:
Using the Palliative Care Quiz for Nursing (PCQN), 140 oncology and intensive care unit (ICU) nurses' knowledge about palliative care in three hospitals supervised by Kerman University of Medical Sciences was assessed.
Results:
In PCQN, the mean score was 7.59 (SD: 2.28). The most correct answers were in the category of management of pain and other symptoms (46.07%). The lowest correct answers were in the category of psychosocial and spiritual care (19.3%).
Significance of results:
These findings suggest that nurses' knowledge about palliative care can be improved by establishing specific palliative care units to focus on end-of-life care. This establishment requires incorporation of an end-of-life nursing education curriculum into undergraduate nursing studies.
To examine the attitudes of Iranian nurses toward caring for dying patients.
Methods:
Nurses' attitudes toward death and caring for dying patients were examined by using two types of questionnaires: the Death Attitude Profile–Revised (DAP-R) and Frommelt's Attitude towards Caring for Dying Patients (FATCOD), both with a demographic survey.
Results:
The results showed that most respondents are likely to view death as a natural part of life and also as a gateway to the afterlife. The majority reported that they are likely to provide care and emotional support for the people who are dying and their families, but they were unlikely to talk with them or even educate them about death. They had a tendency not to accept patients and their families as the authoritative decision makers or involve families in patient care. Nurses' personal views on death, as well as personal experiences, affected their attitudes toward care of the dying.
Significance of results:
Lack of education and experience, as well as cultural and professional limitations, may have contributed to the negative attitude toward some aspects of the care for people who are dying among the nurses surveyed. Creating a reflective narrative environment in which nurses can express their own feelings about death and dying seems to be a potentially effective approach to identify the factors influencing their interaction with the dying. Continuing education may be required for Iranian palliative care nurses in order to improve the patients quality of care at the end of life.
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