Palliative Care Competencies Research Articles

Undergraduate training in palliative medicine in Germany: what effect does a curriculum without compulsory palliative care have on medical students’ knowledge, skills and attitudes?

Introduction: The effect of a curriculum without compulsory courses in palliative medicine on students’ knowledge, kills and attitudes towards the care of dying patients and decisions at the end of life was investigated. Methods: In a cross sectional, questionnaire based survey at the medical school of Bonn 1st, 3rd and 5th year students had to grade their knowledge and skills in items concerning palliative medicine. Attitudes towards end of life decisions were queried. Results: The return rate was 78%. Significant increase in self estimation of certainty comparing 1st to 5th year students were detected for the items distinction between palliative and curative medicine (p <0.001), symptom control (p <0.001), pain management (p =0.001) and communication (p =0.036). No significant differences were recorded for the items accompaniment of dying patients, breaking bad news and integration of spiritual aspects. The low overall certainty is reflected in poor knowledge. A significant decrease of the approval for euthanasia by request was evident (p =0.012). Discussion: A medical curriculum without compulsory course does increase confidence in some of the core competencies in palliative care, but the overall results at the end of the training are poor. The WHO claims that palliative care has to be “compulsory in courses leading to a basic professional qualification” has still to be fulfilled in Germany. This study can serve as a baseline to evaluate the effect of mandatory courses in palliative care.

Hopeful Thinking and Level of Comfort Regarding Providing Pediatric Palliative Care: A Survey of Hospital Nurses

The purpose of this work was to test the hypothesis that individual nurses' level of hope is associated with greater self-reported comfort and competence in providing palliative care. We conducted a Web-based cross-sectional survey at the Children's Hospital of Philadelphia, a large referral hospital, during the spring of 2005 with all of the employed nurses. The response rate was 44% (410 of 932 eligible nurses). The questions were adapted from published studies or written for this study regarding nurses' knowledge, attitudes, practices, and experiences regarding various aspects of palliative care. We used the Adult Dispositional Hope Scale. Respondents, asked to rate their degree of agreement (+2, strongly agree to -2, strongly disagree) with the statement that they were "comfortable working with dying children and their families," reported a mean score of 0.5. Regarding whether they "find it very difficult to talk about death and dying with children and families," the mean score was -0.1. Nurses specifically reported feeling most competent regarding pain management and least competent regarding talking with children and families about dying. After multivariable adjustment, greater number of years in nursing practice, more hours of palliative care education, and higher scores on the Hope Scale, each were significantly associated with higher levels of comfort working with dying children and the families, lower levels of difficulty talking about death and dying, and higher levels of palliative care competency. Nurses' level of hope is associated with their self-reported comfort and competence regarding palliative care.

Chinese Community Views: Promoting Cultural Competence in Palliative Care

Chinese Community Views: Promoting Cultural Competence in Palliative Care

Misrepresentations about palliative options and prognosis in motor neurone disease: some legal considerations

If euthanasia were legalized, clinicians would be under a duty to explain to patients requesting euthanasia what the prognosis and palliative options were. Anecdotal evidence suggests that some patients suffering from motor neurone disease may request euthanasia because of a fear of choking to death. The literature indicates that with competent palliative care this is unlikely to occur. It is assumed, for the purposes of argument, that responsible clinicians would accordingly reassure patients that such a fear was unwarranted, and that such a reassurance would cause patients for whom choking was the main concern either to withdraw a request for euthanasia or not to make it in the first place. The legal consequences of both negligent and deliberate failure to represent the true prognostic and palliative situation are discussed. In the case of a deliberate failure, with the intention to induce the patient to consent to euthanasia, it is suggested that a verdict of murder would be ethically right. It is argued that such a failure is best regarded as an omission. The English law currently does not countenance the possibility of murder by omission. It is suggested that the distinction between acts and omissions, while sometimes convenient, can sometimes produce injustice, and that the distinction should not be allowed to prevent conviction for murder where this is clearly appropriate.

Nurse prescribing in palliative care

Since the introduction of the nurse prescribing initiative in the UK a decade ago, the list of medicines that specially trained nurses can prescribe has developed as steadily as the number of nurses undertaking approved courses of preparation. The development of a nurse prescriber’s formulary and extended formulary and, subject to parliamentary approval, supplementary prescribing, means that suitably skilled and competent palliative care nurses are able to provide patients with effective, efficient and expert clinical management to enhance care and comfort. This month’s Web Words considers sites that offer valuable content and commentary on this subject.

Enhancing Cultural Competence in Palliative Care: Perspective of an Elderly Chinese Community in Calgary

Enhancing Cultural Competence in Palliative Care: Perspective of an Elderly Chinese Community in Calgary

Communication in the development of culturally competent palliative care services in the UK: a case study.

Research suggests that many minority ethnic patients who receive palliative care in the UK are satisfied with the service they are given. However, various studies have revealed that minority ethnic groups' experiences of care are far from perfect. The most significant problem for these patients centres on communication. This article presents some results from an exploratory study, commissioned by Luton Health Action Zone, to explore the role of communication in delivering effective palliative care services to South Asians living in Luton. Overall, it was found that the services provided are, in most cases, valued and seen as being effective. However, as the service providers who were interviewed readily recognized, there were areas where improvements could be made. The main issues were found to be the need to inform South Asian populations of the availability of palliative care services and the need to improve communication between patients and service providers. This article describes the communication problems that service providers and users face. It also identifies possible policy improvements aimed at developing the 'cultural competency' of services.

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<h3>Introduction</h3> Offering choice about place of care to patients is fundamentally influenced by out-of-hours service provision. Concerns have been raised about continuity, availability of information and access to support services. General practitioners (GPs) provide most care out-of-hours, but see few palliative patients. Keeping knowledge up-to-date is challenging. <h3>Aim(s) and method(s)</h3> To explore the views, confidence and educational preferences of out-of-hours GPs in order to inform recommendations for future education. Structured postal survey sent to 1005 GPs across England employed by an independent provider of out-of-hours services. <h3>Results</h3> 203 GPs completed the questionnaire (response rate 20.3%). Organisational factors were felt to have significantly greater impact on care delivery than clinical factors (p&lt;0.0005): lack of familiarity, time pressures and lack of information from in-hours services were ranked highest. Confidence in assessing palliative care emergencies (42.8%, n=87: ‘not so confident’ or ‘not at all confident’), managing symptoms in non-cancer patients (39.4%, n=80) and prescribing a new syringe driver (39.0%, n=79) was lowest. Low confidence was associated with infrequent exposure (p&lt;0.05) and lack of training (p&lt;0.05). Educational preferences were strongly associated with confidence (p&lt;0.0005); the above topics were most requested. E-learning was the preferred method (67.5%, n=137). 82.1% (n=165) felt training focused on out-of-hours work would be beneficial. <h3>Conclusion(s)</h3> Organisational factors continue to hinder care delivery, but confidence in key palliative care competences is lacking. Educational strategies must be targeted at GPs needs, both in terms of content and delivery. Specialist palliative care services should engage with out-of-hours providers to support education.

Palliative care nursing: ensuring competent care at the end of life.

Major advances in enabling function and symptom management have occurred in the past decade. Older adults who would have been bed-bound at the end of life now can be offered interventions to help them live well until they die. People who once would have suffered from pain can expect to be kept comfortable with aggressive symptom management. Palliative care nursing is the art and science of quality end-of-life care. Appropriate interventions for competent palliative care often are not initiated for dying older adults and their families. Nursing professionals are beginning to assume leadership roles to ensure that comprehensive, holistic end-of-life care is available to all patients and families experiencing life-threatening progressive illnesses.

Palliative care nursing: quality care to the end of life

These authors and the pages of this text...create the blueprint that will build the kind of care system we all wish for our loved ones. - From the Foreword by Betty Rolling Ferrell, RN, PhD, FAAN. The second edition of this award-winning text provides the essential guide to achieving best practices in palliative care nursing. It offers a blend of holistic, spiritual, cultural, and humanistic caring coupled with aggressive management of pain and symptoms associated with advanced disease. With over 20 per cent of the book covering pharmacologic and non-pharmacologic pain management and with a focus on both clinical and holistic treatment, major figures in the field of palliative care nursing outline eleven specific skill competencies in this specialty. Used as a resource in the End-of-Life Nursing Education Consortium supported by the Robert Wood Johnson Foundation and the National Cancer Institute, which has successfully trained thousands of nurse educators, and organized around the competencies in palliative care nursing developed by the American Association of Colleges of Nursing, this book is an essential resource for both students and practitioners. Features new to the 2nd edition include: updated information in each chapter; new chapter on professional organizations; and certification in palliative care nursing.

Do cancer suicides differ from others?

AbstractBased on a nationwide psychological autopsy study comprising all suicides committed in Finland during one year (n = 1397), victims who had suffered from cancer (n = 60) were compared with other suicides. Cancer suicides were significantly older and more often male, which required adjusting the control group (n = 60) for age and sex. The cancer suicides had more pain and were more often physically disabled. The social network of cancer patients was stronger: 93% of them and 65% of the control cases had a significant other. Family histories of mental disorder were more common in the control group. Cancer was the main underlying factor in the suicide process in 62% of the cancer patients and a contributing factor in 23%. Background factors of the suicide process of the cancer patients with terminal illness (n = 18) were different from those with cancer in remission and from victims among the general population. The frequency of physical symptoms and of depression before suicide in cancer patients emphasizes the need for more competent palliative care and psychological support for cancer patients.

Bedside Assessment of Competency in Palliative Care

Bedside Assessment of Competency in Palliative Care