Palliative Care Communication Skills Research Articles

Community Palliative Care Nurses' Challenges and Coping Strategies on Delivering Home-Based Pediatric Palliative Care.

The aim of this study was to explore the experience of community palliative care nurses providing home care to children. A qualitative study was conducted at the 3 community palliative care provider organizations in greater Kuala Lumpur from August to October 2014. Data were collected with semistructured interviews with 16 nurses who have provided care to children and was analyzed using thematic analysis. Two categories were identified: (1) challenges nurses faced and (2) coping strategies. The themes identified from the categories are (1) communication challenges, (2) inadequate training and knowledge, (3) personal suffering, (4) challenges of the system, (5) intrapersonal coping skills, (6) interpersonal coping strategies, and (7) systemic supports. These results reinforces the need for integration of pediatric palliative care teaching and communication skills training into all undergraduate health care programs. Provider organizational support to meet the specific needs of the nurses in the community can help retain them in their role. It will also be important to develop standards for current and new palliative care services to ensure delivery of quality pediatric palliative care.

Interdisciplinary Family Meetings with Structured Debriefings Are Effective to Educate Surgical Residents in Palliative Care Communication Skills (FR408-A)

Background. Life-sustaining therapy is commonly withdrawn in intensive care units, yet little is known about the perceptions of families when a critically ill patient dies after life-sustaining treatment is withdrawn. Research Objectives. The purpose of this study was to understand the lived experience of families when a family member who had an unexpected life-threatening illness or injury died after life-sustaining therapy was withdrawn. Methods. A hermeneutic phenomenological study was conducted. Family members were interviewed 1-2 years after the patient’s death. All patients died in the critical care setting. Each interview was audiotaped. All interview transcripts were transcribed with units of meaning and clusters, and then categories were inductively determined. Within and across family analyses were conducted. Methodological rigor was established. Results. Twenty-two family members participated in the study. The categories that evolved from the data included: preparing for the dying process, the dying environment, perceptions of patient comfort, the death vigil, and essential aspects of care. Some families felt better prepared than others for the dying process. Families also had varying views of their family members’ level of comfort. Families described the death vigil as extremely difficult. Family members described several aspects of nursing care that were very meaningful to them during the dying process. Families described how important it was for the family to be together as a family during the dying process. Conclusions. Families need to be prepared, guided, and supported through the dying process. Healthcare providers need to provide quality end-of-life care to patients and families before and after the withdrawal of life-sustaining therapy. Implications for research, policy, or practice. Families need to be encouraged to take family leave and to ask support from their employers so that they can be present during the dying process of a loved one. Clinicians need to prepare families for what to expect before and during the active phase of dying. Additional research needs to be conducted to further understand what helps to prepare families for the dying process. Interdisciplinary Family Meetings with Structured Debriefings Are Effective to Educate Surgical Residents in Palliative Care Communication Skills (FR408-A) Sangeeta Lamba, MD, Rutgers New Jersey Medical School, Newark, NJ. Leslie Tyrie, MD, Rutgers New Jersey Medical School, Newark, NJ. Anne Mosenthal, MD FACS, Rutgers New Jersey Medical School, Newark, NJ. Janet Smith. (All authors listed above had no relevant financial relationships to disclose.)

Teaching Others Palliative Care Communication Skills: Piloting an Interdisciplinary Workshop Focused on the Care of Older Adults with Life-Limiting Illness (S733)

Teaching Others Palliative Care Communication Skills: Piloting an Interdisciplinary Workshop Focused on the Care of Older Adults with Life-Limiting Illness (S733) Neha Jeurkar University of Pennsylvania, Philadelphia, PA. Eunhae Kim, MSW, University of Pennsylvania, Philadelphia, PA. Zvi Gellis, PhD, University of Pennsylvania, Philadelphia, PA. Amy Corcoran, MD CMD, University of Pennsylvania, Philadelphia, PA. Cathy Poon, PharmD, University of the Sciences, Philadelphia, PA. Christine Bradway, PhD RN, Unversity of Pennsylvania School of Nursing, Philadelphia, PA.

The Use of Role Play for Interdisciplinary Teaching of Palliative Care Communication Skills

The Use of Role Play for Interdisciplinary Teaching of Palliative Care Communication Skills

Follow-up evaluation of a course to develop effective communication and relationship skills for palliative care

This paper reports on a longitudinal follow-up evaluation of an interprofessional experiential course to support the development of effective communication and interpersonal relationship skills in palliative care: 'It's good to listen: advanced communication skills in end of life care'. The course was developed from evidence-based guidance produced by the West of Scotland Cancer Network and NHS Education for Scotland in 2009. The aim of the study was to explore the factors that support or hinder the sustainable integration of skills and learning from the course into clinical practice. Three focus groups were held across the NHS Board area. Following analysis of the transcripts the emergent themes were grouped under four headings; impact on practice, facilitating factors, hindering factors, and organisational issues. The findings suggest that organisations should consider the value they place on supporting interpersonal skills in end-of-life care and how they can enhance sustainability and behavioural change.

Specific Training Program Improves Oncologists' Palliative Care Communication Skills in a Randomized Controlled Trial

The aim of the study was to demonstrate that COM-ON-p, concise and individualized communication skills training (CST), improves oncologists' communication skills in consultations focusing on the transition to palliative care. Forty-one physicians were randomly assigned to a control (CG) or intervention group (IG). At t(0), all physicians held two video-recorded consultations with actor-patient pairs. Afterward, physicians in the IG participated in COM-ON-p. Five weeks after t(0), a second assessment took place (t(1)). COM-ON-p consists of an 11-hour workshop (1.5 days), pre- and postassessment (2 hours), and coaching (0.5 hours). Physicians focused on practicing individual learning goals with actor patients in small groups. To evaluate the training, blinded raters assessed communication behavior of the physicians in video-recorded actor-patient consultations using a specific checklist. Data were analyzed using a mixed model with baseline levels as covariates. Participants in the IG improved significantly more than those in the CG in all three sections of the COM-ON-Checklist: skills specific to the transition to palliative care, global communication skills, and involvement of significant others (all P < .01). Differences between the CG and IG on the global items of communication skills and involvement of significant others were also significant (P < .01). Effect sizes were medium to large, with a 0.5-point improvement on average on a five-point rating scale. Physicians can be trained to meet better core challenges during the transition to palliative care through developed concise CST. Generalization and transfer into clinical practice must be proven in additional studies.

Patients’ Unrealistic Hopes for Cancer Trial Benefits May Hinder Consent

along with standard oncological treatment had a better quality of life and were less likely to have depressive symptoms (16% in this group) compared with those receiving standard care alone (38%). The palliative care patients also had a longer median survival (11.6 months vs 8.9 months) than patients receiving standard care, even though fewer in the palliative care group received aggressive end-of-life treatment (33% vs 54%) (Temel JS et al. N Engl J Med. 2010; 363[8]:733-742). In light of such data, ASCO’s policy statement urges physicians, medical educators, and policy makers to make sure more patients get the information and care that best meets their needs. The statement encourages the incorporation of palliative care and endof-life care communication skills into medical education and certification programs. Additionally, it calls upon public and private insurers to reimburse physicians for advance care planning discussions and to find ways to promote palliative care. But Sledge acknowledged political obstacles to improving reimbursement. Such reimbursement has twice been dropped from federal health reform efforts after such discussions were labeled “pulling the plug on granny” or “death panels.” “It got politicized when it shouldn’t have,” he said. The result is a system in which Medicare and other insurance providers will pay physicians to provide expensive and potentially inappropriate therapy but not pay for a 1-hour conversation about end-of-life care options. He said he hoped that educating lawmakers would help. The statement also calls for more research on the best care options for patients with advanced cancer. It urges physicians to discuss the possibility of participation in clinical trials as an option for patients with advanced cancer early in the course of therapy rather than “holding out trials as a potentially unrealistic last resort.” Currently, only about 3% of adult patients with cancer participate in such trials. In the meantime, ASCO advises physicians to develop the skills they need for advising patients on end-of-life care planning. Sledge recommended that physicians start these conversations early in the course of treatment and that they be “frank and open.” He also emphasized the importance of involving family members in these discussions, and making sure to appropriately document patients’ wishes to ensure they are respected. “This is not high-tech medicine; it’s high-touch medicine,” he said. Physicians, he added, should work with a team of nurses, hospice workers, and perhaps even clergy to help each patient navigate these challenging decisions. ASCO plans to publish a guideline for physicians later this year on endof-life care discussions and has also created a patient guide that physicians can share with their patients (http: //tinyurl.com/4f6auf8). The guide explains various care options, including palliative and hospice care, and offers vignettes of patients’ experiences.

Paediatric palliative home care by general paediatricians: a multimethod study on perceived barriers and incentives

BackgroundNon-specialist palliative care, as it is delivered by general practitioners, is a basic component of a comprehensive palliative care infrastructure for adult patients with progressive and far advanced disease. Currently palliative care for children and adolescents is recognized as a distinct entity of care, requiring networks of service providers across different settings, including paediatricians working in general practice. In Germany, the medical home care for children and adolescents is to a large extent delivered by general paediatricians working in their own practice. However, these are rarely confronted with children suffering from life-limiting diseases. The aim of this study was therefore to examine potential barriers, incentives, and the professional self-image of general paediatricians with regard to paediatric palliative care.MethodsBased on qualitative expert interviews, a questionnaire was designed and a survey among general paediatricians in their own practice (n = 293) was undertaken. The survey has been developed and performed in close cooperation with the regional professional association of paediatricians.ResultsThe results showed a high disposition on part of the paediatricians to engage in palliative care, and the majority of respondents regarded palliative care as part of their profile. Main barriers for the implementation were time restrictions (40.7%) and financial burden (31.6%), sole responsibility without team support (31.1%), as well as formal requirements such as forms and prescriptions (26.6%). Major facilitations were support by local specialist services such as home care nursing service (83.0%), access to a specialist paediatric palliative care consultation team (82.4%), as well as an option of exchange with colleagues (60.1%).ConclusionsAltogether, the high commitment to this survey reflects the relevance of the issue for paediatricians working in general practice. Education in basic palliative care competence and communication skills was seen as an important prerequisite for the engagement in paediatric palliative home care. A local network of specialist support on site and a 24/7 on-call service are necessary in order to facilitate the implementation of basic palliative care by paediatricians in their own practice.

Communication Skills in Palliative Care

Communication Skills in Palliative Care

Applied Knowledge Test on Palliative Care-Communication Skills

Applied Knowledge Test on Palliative Care-Communication Skills

Feasibility of A Brief Workshop on Palliative Care Communication Skills for Medical Interns

This report describes a novel 3-hour workshop on delivering bad news and discussing end-of-life goals of care for internal medicine interns, and its effect on the interns' attitudes, knowledge, and confidence in discussing these topics with patients. Interns participated in a 3-hour workshop involving role-playing, focused on teaching core knowledge, skills, and attitudes associated with delivering bad news and discussing goals of care at the end of life. One to 3 weeks before and after the workshop, participants completed a written questionnaire that included 54 knowledge questions, 6 questions eliciting their perceived level of confidence, and 11 questions about attitudes toward delivering bad news or discussing goals of care. Immediately after the workshop, interns answered questions rating their satisfaction with the workshop. Of 43 interns who took the pretest, 29 completed the posttest. There was a high degree of satisfaction with the workshop. Mean knowledge scores increased by 4 points (from 41.4 to 45.4, p < 0.001). The percentage of interns who expressed confidence increased. There was no change in interns' attitudes.

Palliative care nursing: a continuum of practice from a generalized approach to a specialized disciplinePallative Care Nursing. A Guide to Practice, 2nd ed. Edited by Margaret O'Connor and Sanchia Aranda Published by Radcliffe Medical Press, Oxford, United Kingdom, 2003387 pages, $dollar;60 (soft cover)

This palliative care nursing guide to practice is highly recommended, and will help any nurse caring for a patient with progressive debilitating disease to understand, individualize and provide the care that is needed. It is especially useful as an introductory text for those new to the field, but seasoned palliative care practitioners will also benefit from reading this text. Written in the main by nurses practicing in Australia and England, this book provides a broad framework for evidence-based palliative care nursing. This second edition has been expanded to include some international authors, although the practice models tend to be those of Australia and England. The nursing principles and practices described, however, have universal applicability. The text is rich with references and is of a size and format that makes it user friendly. Its organization rightly reflects the importance of communication skills, understanding nursing stressors in palliative care, as well as ethical decision-making and spirituality as a prelude to approaching other aspects of palliative care. The book is divided into 24 chapters, each of which starts with a brief introduction about the author and his/her clinical setting. This format is useful as it illustrates the wide arena within which palliative care is practiced. The chapters are organized into three main sections. The first section, “Framing Palliative Care,” includes chapters on the principles of evidence-based practice, communication skills in palliative care, occupational stress in palliative care, ethical decision-making, and spiritual care. The section on “Symptom Control” includes chapters on pain management, breathlessness, fatigue, constipation, nausea and vomiting, nutrition and hydration, malignant wounds, confusion and terminal restlessness, psychological and existential distress, sexuality and body image, and complementary therapies. The third section includes areas that are frequently lacking in palliative care texts, including chapters on working with families, bereavement, palliative care in chronic illness, aging, dementia and palliative care, caring for dying patients in critical care, and pediatric palliative care. The selective use of case studies in several of the chapters, a long nursing tradition, is a helpful way of illustrating key points. The case studies are particularly helpful in the chapters on ethical decision-making, spiritual care, and confusion and restlessness. Broad principles of nursing assessment and management underpin each of the chapters. Where pharmacotherapy is discussed, some chapters are quite specific regarding a step-by-step approach to symptom management (e.g., the management of constipation), while others are more general. For the more general chapters, the nurse will need to refer to other texts to get specifics on the “how to.” In each chapter, however, nursing care and the pivotal role of the nurse in facilitating palliative care for the patient, is strongly evident. This palliative care nursing guide to practice stands out in its recognition that nurses working with progressive, incurable illness and associated distressing symptom clusters need the tools to analyze and evaluate the literature and research that informs their clinical practice. The chapter on evidence-based practice provides both the insight and tools that make this possible. Lucid and practical checklists are provided for assessing the validity of both quantitative and qualitative research studies. This book beautifully illustrates the depth and rewards of palliative care nursing as a continuum of practice—from a generalized approach helpful to most patients to a specialized discipline in caring for the terminally ill.

Communication skills in palliative care: A practical guide

Communication skills are frequently regarded as innate and intuitive. Many studies, however, now show that most components of communication techniques can be taught and that these learned skills have an impact on the physician's ability to communicate. This article sets out two fundamental protocols that act as templates or strategies for communication. One, (the C-L-A-S-S strategy) highlights the five central factors in all clinician-patient interviews. The second (the S-P-I-K-E-S protocol) is a variant for the specific task of breaking bad news.

An audit of out-of-hours advice services provided by hospice staff.

For those giving and receiving health care there will always be problems and queries which occur outside of normal office hours. Palliative care is no exception. It was found that Queenscourt Hospice in Southport was being used as an accessible point of contact for specialist palliative care advice by patients, relatives and health professionals. In response, an audit was undertaken to monitor the frequency and substance of the many drop-in visits and telephone calls to the hospice. The results showed that almost half of the calls/visits received are outside office hours. This article describes the nature of the calls and the advice offered by the staff taking the call. As the majority of the 'out-of-hours' calls/visits were taken by nursing staff, it was necessary for them to draw on their specialist palliative care knowledge and communication skills to make an assessment of how best to deal with each situation. As a result of the audit, several organizational and educational initiatives have been developed to further improve the service offered.

Communication skills in palliative care: development and modification of a rating scale

Communication skills in palliative care: development and modification of a rating scale

Communication skills in palliative care: development and modification of a rating scale

A complex rating scale has been used to evaluate the verbal communication skills of health professionals before and after training. The scale has been modified in order to decrease the useage time, to improve its accuracy and to develop a rating tool available to teachers. This paper describes the process of the modification and discusses the consequent validation of the scale.

Using simulators to aid the teaching of communication skills in cancer and palliative care

The involvement of simulators for training health professionals to improve their interactive skills appears to be successful. They allow health professionals to practice in a relatively safe environment and to have useful feedback based on a positive approach and constructive suggestion. The simulators appear to find the experience very rewarding. The costs are small and can be built into course fees.

Communication and counseling skills: Educating health professionals working in cancer and palliative care

There is a growing awareness of the need for health professionals to improve their communication and counseling skills in cancer and palliative care. A model for teaching these skills to multidisciplinary groups has been established by Maguire and Faulkner. Courses are held several times a year subsidized by the UK national charity, Help the Hospices. To further this work, a national training coordinator was appointed for three years from July 1988, also funded by the charity, to establish and monitor locally based courses through the United Kingdom using this same model. Evaluation of the original courses and the development of locally based courses is underway.