Racial Differences in Palliative Care Consultation for Inpatients with Advanced Cancer (SA523-A)

Abstract

Objectives 1. Discuss the benefit of learner exposure to last hours of life curriculum. 2. Increase knowledge of the needs of patients and their families during the last days and hours of life. Background. The need for end-of-life education to prepare medical students to communicate with dying patients and their families and to cope with issues of death and dying is well recognized. This paper examines the effectiveness of a unique, multimedia curriculum focusing on end-of-life patient/family care. Research Objectives. 1) To increase the learners’ facility, confidence, and willingness to approach end-of-life discussions with dying patients and their families. 2) To increase the learners’ knowledge of the needs of patients and their families during the last days and hours of life. Methods. Third-year medical students (n1⁄4222) during their ambulatory rotation completed the curriculum, which included pre-/post-tests, an online case-based module, and a tablet computer application demonstrating the signs and symptoms seen in the last hours. Pre-/post-tests consisted of FATCOD -FormB (Murray Frommelt) d30 questions (validated survey on attitudes toward caring for terminally-ill patients/families). Pre-/post-tests were compared using Pearson Chi Square or Fisher’s Exact test. Kappa statistics were used to examine improvement. Results. There was a statistically significant increase in positive attitudes toward caring for dying patients (P<0.0001), willingness to discuss death and dying with patients and their families (P1⁄40.0005), and recognition that families need emotional support and involvement in the patient’s care (P<0.0001). There was a statistically significant increase in the students’ uncertainty about including patients in decisions about their own physical care (P1⁄40.0025) and whether it is beneficial for the dying person to verbalize his/ her feelings(P<0.0001). Conclusions. Medical students’ exposure to an end-of-life curriculum increases learner comfort and willingness to care for dying patients and their families and helps students appreciate the benefits of caring for patients in their last hours of life. Implications for research, policy, or practice. Using a multimedia-based curriculum to improve learners’ comfort and willingness to take care of patients in their last hours of life has sustainability through technologic design and may encourage sharing of knowledge within the profession to improve patient/family care. This curriculum can be implemented easily at other sites and can be expanded to include a multitude of palliative education topics.