Self-efficacy In Palliative Care Research Articles

Effect of Online Palliative Care Training on Knowledge and Self-Efficacy of Direct Care Workers.

We evaluated the effectiveness of an online training on palliative care knowledge and self-efficacy among staff working with people with intellectual and developmental disabilities (IDD) using a one-group pretest-posttest design. Staff from four nonprofit residential and day services organizations in a U.S. Midwestern state participated. Among 132 staff who completed a baseline assessment, a 2-hour online training, and a posttest, 98 staff completed a 1-month follow-up survey. Palliative care knowledge was assessed before and after the training, and palliative care self-efficacy, at baseline and 1-month follow-up. We used linear regression to identify the factors that influence the effect of the training on main outcomes. Overall palliative care knowledge and self-efficacy significantly improved while higher education and longer work tenure enhanced training effectiveness.

NUrsing Homes End of Life care Program (NUHELP): developing a complex intervention

BackgroundNursing homes are likely to become increasingly important as end-of-life care facilities. Previous studies indicate that individuals residing in these facilities have a high prevalence of end-of-life symptoms and a significant need for palliative care. The aim of this study was to develop an end-of-life care program for nursing homes in Spain based on previous models yet adapted to the specific context and the needs of staff in nursing homes in the country.MethodsA descriptive study of a complex intervention procedure was developed. The study consisted of three phases. The first phase was a prospective study assessing self-efficacy in palliative care (using the SEPC scale) and attitudes towards end-of-life care (using the FATCOD-B scale) among nursing home staff before and after the completion of a basic palliative care training program. In the second phase, objectives were selected using the Delphi consensus technique, where nursing home and primary care professionals assessed the relevance, feasibility, and level of attainment of 42 quality standards. In phase 3, interventions were selected for these objectives through two focus group sessions involving nursing home, primary care, and palliative care professionals.ResultsAs a result of the training, an improvement in self-efficacy and attitudes towards end-of-life care was observed. In phase 2, 14 standards were selected and grouped into 5 objectives: to conduct a comprehensive assessment and develop a personalized care plan adapted to the palliative needs detected; to provide information in a clear and accessible way; to request and record advance care directives; to provide early care with respect to loss and grief; to refer patients to a specialized palliative care unit if appropriate, depending on the complexity of the palliative care required. Based on these objectives, the participants in the focus group sessions designed the 22 interventions that make up the program.ConclusionsThe objectives and interventions of the NUHELP program constitute an end-of-life care program which can be implemented in nursing homes to improve the quality of end-of-life care in these facilities by modifying their clinical practice, organization, and relationship with the health system as well as serving as an example of an effective health intervention program.

Palliative Care Education: Its Effect on Nurses’ Competency during Care of Dying Patients

Background: Palliative care can play a major role in relieving both physical and mental symptoms of the dying patient. Nurses are the key valuable palliative care team members who are responsible for the dimension of physical, functional, social, and spiritual patients' care. Essential factors affecting a successful implementation of palliative care are nurses' knowledge, attitude and self efficacy for providing care to these patients. Aim of the study: To examine impact of palliative care education on nurses’ competency during care for dying patients. Methods: A quasi-experimental design was utilized. Setting: The study was conducted at oncology institute, general medical and general surgical unit of Menoufia University hospital. Subjects: A convenience sample of 120 nurses (52 from oncology institute, 34 from general medical and 34 general surgical unit) of Menoufia University who agreed to participate in this study were divided alternatively and randomly into two equal groups, 60 for group 1 and 60 for group 2.Tools: four tools were utilized by the researchers. Tool I: Structural interviewing questionnaire, Tool II: Palliative Care Quiz for Nursing, Tool III: The Frommelt Attitudes Toward Care of the Dying scale and Tool IV: The Palliative Care Self-Efficacy Scale. Results: the mean total score of Palliative Care nurses’ knowledge in study group (16.48±1.88)was better than control group (7.23± 2.68), nurses' attitude toward palliative care of study group was 113.50±10.75 as compared to 91.21±12.40of control group and palliative care self-efficacy score of study group was 28.06±7.38 as compared to16.08±4.49 of control group at post-intervention. Conclusion: palliative care educational intervention to nurses can be effective in strengthening their knowledge base, improving attitude and level of self efficacy toward care of dying patient. Recommendations: Education and training programs about palliative care with simple illustrated booklet required for all nursing staff in health care setting

Exploring paramedics’ intention to use a specialist palliative care telehealth service

A large proportion of expected deaths do not occur at home, despite often being the dying person’s preference. Paramedics play an integral role in hospital admissions when someone is close to death. As illness worsens, paramedics are often called and ascertain whether hospitalisation is appropriate. In a 12-month period, Ambulance Victoria (Australia) recorded 4348 palliative related callouts, 70% resulting in hospitalisation. Paramedics throughout the world recognise the need for extra palliative care training or support. One solution is a specialist palliative care support telehealth service from palliative specialists (usually in tertiary hospitals) to paramedics on call-outs to people with life-limiting illnesses. However, to maximise uptake and sustainability, it is prudent to examine factors that influence acceptance of such a service. In the current study, 112 paramedics employed by the Queensland Ambulance Service completed an online survey examining their Intention to Use the Specialist Palliative Care telehealth service as a function of the Technology Acceptance Model constructs (Perceived Usefulness, Perceived Ease of Use and Attitudes toward technology) and Palliative Care Self-Efficacy. After controlling for age, a hierarchical multiple regression analysis demonstrated the predictive utility of Perceived Usefulness and Attitudes. Palliative Care Self-efficacy did not add any significant variance to the model. This research highlights the importance of addressing paramedics’ perceptions regarding the telehealth service and its usefulness when implementing a similar service model.

The Effect of Spiritual Counseling and Hope Therapy Training on Palliative Care Self-efficacy of Nursing Students of Urmia Azad University.

The Effect of Spiritual Counseling and Hope Therapy Training on Palliative Care Self-efficacy of Nursing Students of Urmia Azad University.

Evaluation of Online Palliative Care Training for Certified Nursing Assistants

Palliative care for older adults is increasingly needed due to a burgeoning older adult population. Certified nursing assistants (CNAs) in skilled nursing facilities (SNFs) provide assistance with activities of daily living and comfort care. There, however, is a significant gap in evaluated palliative care trainings for CNAs. We used a waitlisted control group design to evaluate the effectiveness of an 8-module online palliative care training. CNAs (n=102) from 6 SNFs were randomly assigned to an experimental (n=51) and a control group (n=51) and completed a baseline evaluation. The experimental group took a posttest about palliative care knowledge upon training completion and a 1-month follow-up assessment about palliative care self-efficacy. The control group completed the assessments at the same time as the experimental group prior to receiving the training. The majority of the participants were female (92%). On average, participants were 31 years old, with 6.5 years tenure in the field. The retention rate was 90% at the posttest (n=92) and 82% at the 1-month follow-up (n=84). Palliative care knowledge (scored 0–100) significantly increased in the experimental group (mean 4.1, p < 05), with no significant change in the control group. Palliative care self-efficacy (scored 20-100) significantly improved from the baseline to follow-up in both groups (mean 4.3 and 5.8 respectively, p < 05) with no significant difference between study groups. The results indicate the effectiveness of an online palliative care training to improve CNA knowledge. Improvement in palliative care self-efficacy regardless of training participation warrants further exploration.

Examining the effect of non-specialised clinical rotations upon medical students’ Thanatophobia and Self-efficacy in Palliative Care: a prospective observational study in two medical schools

IntroductionIncluding palliative care (PC) in overloaded medical curricula is a challenge, especially where there is a lack of PC specialists. We hypothesised that non-specialised rotations could provide meaningful PC learning...

Undergraduate nursing students' knowledge, attitudes and self-efficacy regarding palliative care in China: A descriptive correlational study.

AimTo describe nursing students’ knowledge, attitudes and self‐efficacy about palliative care and to examine the associations between these variables in China.DesignA descriptive correlational study.MethodsUndergraduate nursing students (N = 187) at the end of third year of education from a university were surveyed. Measurements included the Chinese versions of the Palliative Care Quiz for Nursing, the Death Attitude Profile‐Revised, the Frommelt Attitude Toward Care of the Dying Scale and the Palliative Care Self‐Efficacy Scale. Descriptive and correlational analyses were performed.ResultsAlthough most nursing students had favourable attitudes towards death and caring for the dying, students had low level of knowledge and self‐efficacy regarding palliative care, suggesting the need for integrating palliative care education into nursing curriculum in China. Moreover, special attention should be paid to psychosocial and spiritual care teaching and preparing students to psychologically deal with the challenges in the process of patient's dying.

Knowledge, attitude and self-efficacy towards palliative care among nurses in Mongolia: A cross-sectional descriptive study.

BackgroundNurses have a primary role in providing palliative and end-of-life (EOL) care. Their knowledge of EOL care, attitudes toward care of the dying, and palliative care self-efficacy are important in care delivery. Little is known regarding palliative care preparedness among Mongolian nurses. This study examines palliative care knowledge, attitude towards death and dying, and self-efficacy among Mongolian nurses, and examines predictors of self-efficacy.MethodsA cross-sectional descriptive study was conducted. Participants were 141 nurses employed at the National Cancer Center in Mongolia. Data was collected using a self-administered questionnaire.ResultsThe median score for the knowledge of palliative care was 8.0/20. “Psychosocial and spiritual care” was the lowest score on the palliative care knowledge subscale. The mean score for attitude toward care of the dying was 69.1%, indicating positive attitudes. The mean score for the palliative care self-efficacy was 33.8/48. Nurses reported low self-efficacy toward communicating with dying patients and their families, and managing delirium. Palliative care knowledge and duration of experience as an oncology nurse significantly predicted self-efficacy toward palliative care, accounting for 14.0% of the variance.ConclusionsPalliative education for nurses should address the knowledge gaps in EOL care and focus in increasing palliative care self-efficacy. Considering palliative care knowledge and nursing experience as an oncology nurse were significant predictors of self-efficacy toward palliative care, more effort is needed to fill the knowledge gaps in EOL care among nurses, especially for less experienced nurses.

Assessing palliative care education in undergraduate medical students: translation and validation of the Self-Efficacy in Palliative Care and Thanatophobia Scales for Brazilian Portuguese

BackgroundAs the global population ages, palliative care is ever more essential to provide care for patients with incurable chronic conditions. However, in many countries, doctors are not prepared to care...

Death Attitudes, Palliative Care Self-efficacy, and Attitudes Toward Care of the Dying Among Hospice Nurses.

Previous research has linked death attitudes, palliative care self-efficacy, and attitudes toward care of the dying among nursing students and other nursing samples, but not among hospice nurses. The purpose of this study was to investigate these relationships among hospice nurses (N = 90). More positive attitudes toward care of the dying were associated with lower fear of death and death avoidance as well as higher neutral acceptance and escape acceptance, but not with approach acceptance. More positive attitudes toward care of the dying was associated with perceived capability to answer end-of-life concerns, but not with perceived capability to respond to end-of-life symptoms. Clinical interventions seeking to improve attitudes toward care of the dying among hospice nurses may be most effective by targeting death attitudes and improving self-efficacy in the area of discussing end-of-life concerns with patients.

Mind the gap: is the Canadian long-term care workforce ready for a palliative care mandate?

AbstractThe average expected lifespan in Canadian long-term care (LTC) homes is now less than two years post-admission, making LTC a palliative care setting. As little is known about the readiness of LTC staff in Canada to embrace a palliative care mandate, the main objective of this study was to assess qualities relevant to palliative care, including personal emotional wellbeing, palliative care self-efficacy and person-centred practices (e.g. knowing the person, comfort care). A convenience sample of 228 professional and non-professional staff (e.g. nurses and nursing assistants) across four Canadian LTC homes participated in a survey. Burnout, secondary traumatic stress and poor job satisfaction were well below accepted thresholds, e.g. burnout: mean = 20.49 (standard deviation (SD) = 5.39) for professionals; mean = 22.09 (SD = 4.98) for non-professionals; cut score = 42. Furthermore, only 0–1 per cent of each group showed a score above cut-off for any of these variables. Reported self-efficacy was moderate, e.g. efficacy in delivery: mean = 18.63 (SD = 6.29) for professionals; mean = 15.33 (SD = 7.52) for non-professionals; maximum = 32. The same was true of self-reported person-centred care, e.g. knowing the person; mean = 22.05 (SD = 6.55) for professionals; mean = 22.91 (SD = 6.16) for non-professionals; maximum = 35. t-Tests showed that non-professional staff reported relatively higher levels of burnout, while professional staff reported greater job satisfaction and self-efficacy (p &lt; 0.05). There was no difference in secondary traumatic stress or person-centred care (p &gt; 0.05). Overall, these results suggest that the emotional wellbeing of the Canadian LTC workforce is unlikely to impede effective palliative care. However, palliative care self-efficacy and person-centred care can be further cultivated in this context.

Knowledge and Self-Efficacy Assessment of Residents and Fellows Following Palliative Care Unit Rotation: A Pilot Study.

In Germany, some units of specialized palliative care (SPC) offer a 6- to 12-month rotation for resident physicians (RPs) and fellows from different specialties. This pilot study aimed to evaluate feasibility of assessing palliative care knowledge (PCK) and palliative care self-efficacy (PCSE) using a paper-based questionnaire. Palliative care knowledge and PCSE were assessed by introducing a score, followed by a descriptive analysis (determination of frequency, mean, median, and range) using nonparametric tests (χ2 test, Mann-Whitney U test). We assessed 17 RPs following SPC rotation and 16 board-certified specialists (BCSs) who had no experience in SPC from 3 German comprehensive cancer centers. Resident physicians were predominantly enrolled in residency programs of hematology and oncology (n = 6), anesthesiology (n = 6), and psychosomatic medicine (n = 3). Resident physicians rotated between year 1 and 8 of residency. Fifteen RPs (88%) had elected this rotation and 72% preferred 12-month duration. The total PCK score of PCK was 27 (RPs) and 24 (BCSs; P = .002). Mean PCSE scores were 46 (RPs) and 39 (BCSs; P = .016). Of 71% of RPs, only 27% of BCSs knew how support of hospice service was initiated ( P = .004). Participants rated the items as comprehensible (n = 24; 73%), relevant (n = 25; 76%) and the questionnaire as adequately long (n = 23; 70%). An improved PCK and PCSE were observed in physicians who rotated through an SPC unit; this resulted in an increased tangibility of local palliative care and hospice services. The questionnaire was comprehensible, relevant in terms of content, and adequate in length for a prospective multicenter survey.

Are Internal Medicine Residents Meeting the Bar? Comparing Resident Knowledge and Self-Efficacy to Published Palliative Care Competencies (S777)

•Review the development of an instrument to measure internal medicine residents’ baseline knowledge and self-efficacy in palliative care, which is aligned with published palliative care competencies.•Discuss results of our palliative care needs assessment and identify the gaps in resident knowledge, comfort, and ability with core palliative care competencies. We developed a novel instrument based on consensus palliative care (PC) competencies to assess Internal Medicine (IM) residents’ knowledge and self-efficacy (SE) in five core domains of PC: Pain/Symptom Management (PSM), Communication (COMM), PC Principles/Practice (PCPP), Terminal Care/Bereavement (TCB), and Psychosocial/Spiritual/Cultural Aspects of Care (PSC).1 To establish baseline resident knowledge and self-efficacy in proposed PC competencies to identify learning needs and curriculum gaps. A 2-part instrument comprised of 14 knowledge questions and 35 SE items was distributed to incoming, current, and graduating IM residents between June-July 2015. Respondents selected one answer to each multiple choice question, and for each SE statement ranked their knowledge, comfort, or ability on a Likert scale (1=never, 2=sometimes, 3=mostly, and 4=always). We used standard descriptive statistics and Kruskall-Wallace and One-way ANOVA with Tukey Post-Hoc Analysis to identify differences between post-graduate year (PGY). Eighty-three residents completed the survey (30% response). Overall median score on the knowledge test was 79%, with lowest median score of 67% in PSM and highest median score of 100% in PSC. The only significant knowledge difference identified was a higher score in TCB for recently completed PGY-2s (p=0.046). Self-efficacy overall mean score was 2.62 (SD 0.41), with the lowest mean of 2.40 (SD 0.61) in TCB and the highest mean of 2.79 (SD 0.44) in COMM. While PGY-1s reported lowest SE overall and significantly lower SE than PGY2-4 in 3/5 domains (p<0.05), recently completed PGY-2s reported highest SE overall in 4/5 domains. IM residents may not be attaining proposed PC core competencies.

Aid to Our Front Line Warriors: A Brief End-of-Life Communication Curriculum for Internal Medicine Interns (S770)

•Describe the components of a brief end-of-life communication skills training curriculum.•Recognize the benefit of a brief communication training session using a multimodal teaching approach including didactic, simulation and feedback. Internal medicine interns (interns) are the physicians spending the most time with hospitalized patients, frequently assisting with end-of-life (EOL) decision-making. However, most report feeling ill-equipped for these situations. Multimodality hands-on training, including didactics, practice and feedback, have been effective in improving skills/ confidence in EOL communication. To assess a brief hands-on EOL communication curriculum for interns (PC-I). Interns (n=24) participated in PC-I comprised of a one-hour didactic, a one-hour role play, and two observed structured clinical encounters: Breaking Bad News (BBN), Family Meeting (FM) with real-time evaluation (skills checklist/ written comments), and preceptor feedback. Self-Efficacy in Palliative Care (PC) Communication sub-section (SPEC-C) evaluated pre/post curriculum self-assessment of competence. Participants provided subjective post-curriculum impressions. 45.8% had no prior PC training. BBN and FM checklist mean score was 32.2 /45 (Min 18, Max 41, SD 4.67), and 26.6 /39 (Min 15, Max 38, SD 6.12), respectively. Checklist-identified improvement themes: 1) introducing PC; 2) assessing patient/family desire for prognostic knowledge; 3) exploring patient/family emotional state; and 4) summarizing discussion. Preceptor feedback identified four improvement themes: 1) setting meeting agenda “warning-shot”; 2) avoiding medical jargon; 3) discussing prognosis; 4) appropriate utilization of surrogate decision-maker. Intern impressions identified four major themes: 1) safe environment for skills practice; 2) confidence to perform skills in clinical setting; 3) valued feedback; 4) patients/families appreciate direct conversations about death/dying and prognosis. SPEC-C showed improvement in self-perceived confidence discussing patient’s death with patient (p<0.05), with family (p=0.07), with family during bereavement (p<0.05). A brief, hands-on, multimodality EOL communication curriculum is a valuable learning experience for interns at early stages of their career, which can improve confidence and identify specific areas for continued skill development.

The impact of a medical undergraduate student-selected module in palliative care

BackgroundThe need for undergraduate medical education in palliative care is widely recognised. An optional student-selected module ‘Fundamentals of Palliative Medicine’ was introduced in 2011 and offered to third-year medical students....

Caregivers' anxiety and self-efficacy in palliative care

This study examined the relationship between caregivers' anxiety supporting a patient with advanced cancer and self-efficacy and their socio-demographic characteristics, and then whether these variables could influence their self-efficacy. One hundred and seven caregivers of advanced cancer patients participated in the study and completed the Greek versions of the State-Trait Anxiety Inventory (STAI) and the General Perceived Self-efficacy Scale (GSE). Significant comparisons were found between State anxiety and female gender (P= 0.009), cohabitation (P= 0.002) and relationship with the patient (P= 0.004); statistically significant associations were found between State, Trait anxiety and self-efficacy scores of caregivers (P < 0.0005 respectively). A multiple regression model (enter method) showed women (P= 0.005), spouses (P= 0.01) and self-efficacy (P= 0.02) as the significant predictors of State anxiety. Furthermore, self-efficacy seemed to be the strongest contributor of trait anxiety (P < 0.0005). Female caregivers and spouses of advanced cancer patients experience more state anxiety levels than men and other caregivers respectively. In addition, caregivers with low self-efficacy are more likely to have elevated anxiety scores than self-efficacious caregivers. These findings can help healthcare professionals focus on some problems common to caregivers of cancer patients and plan appropriate interventions.