Health professionals deem delirium screening to be important in SPCUs, but may not support routine use of the short CAM. This could reflect a limited perceived impact on care and lack of confidence in this tool to reflect a complex patient group.
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BackgroundThe short-CAM (Confusion Assessment Method) delirium screening tool is validated in the palliative care setting. As an observational tool it is felt to be acceptable in its ease of use, however, some studies highlight challenges in its implementation.Delirium screening using the short-CAM has been incorporated into routine assessment in five North East Specialist Palliative Care In-patient Units (SPCUs).AimsTo assess staff opinion on the importance of screening for deliriumTo determine the acceptability of the short-CAM as a screening tool.MethodsPatients admitted to five SPCUs were regularly screened for delirium using the short-CAM. Clinical and allied health professionals participated in multi-disciplinary assessment of patients to inform short-CAM completion.After four months of use, a voluntary and anonymous survey of staff members was conducted. Verbal rating scales were used to record staff experiences of the tool's implementation, their impression of its value and ease of use.ResultsSixty-three doctors, nurses, allied health professionals and administrators completed the survey.Fifty (79%) respondents believed screening for delirium to be important, however, 62% of those involved in using the short-CAM felt it did not always accurately reflect patients' condition.Sixty-four percent of staff members found the short-CAM “not at all” burdensome to complete, however, only 44% felt the short-CAM should be introduced into routine care. Ten percent of respondents did not feel it should be introduced and 46% were unsure.LimitationsCompletion was voluntary and time limited, creating potential bias in responders.ConclusionsThe majority of health professionals believe screening for delirium to be important in the palliative care setting, however less than half believe the short-CAM should be introduced into routine patient assessment. This is likely to be multi-factorial, relating to paper-work burden, limited perceived impact on patient care and lack of confidence in this tool to reflect a complex patient group.
BackgroundPeer-assisted learning is an established and validated approach to undergraduate education. The peer approach to educating qualified doctors, however, is in its infancy. As such, evidence of the efficacy and acceptability of this educational model is only just emerging. A peer-led Palliative Care study day has been developed by Specialty Trainees in Palliative Medicine in the North East of England and has provided education to five cohorts of junior doctors.AimsTo evaluate the efficacy of a peer-led Palliative Care teaching programme, in terms of knowledge and confidence gained. To evaluate the acceptability of a peer-led Palliative Care teaching programme, specifically in comparison with consultant-led teaching.MethodsParticipants' knowledge and confidence was assessed before and after the study day, using a Multiple Choice Questionnaire (MCQ). Participants in the most recent cohort completed a questionnaire evaluating the acceptability of peer-led teaching.ResultsCombining data from two consecutive study days, the MCQ knowledge scores of 48 participants rose from 50% to 87%. Participants' confidence in managing patients with palliative care needs rose by 38%. All participants reported the teaching to be comparable to, or more effective than consultant-led teaching. Twelve out of 13 participants found peer teachers to be more approachable than consultants. More than half found the relevance, content, preparation and organisation to be more effective than consultant-led teaching.ConclusionsWe demonstrate that peer-led teaching is an effective and positively evaluated method of teaching junior doctors. Successful education relies upon the ability to create a non-threatening atmosphere conducive to learning and the grounding of content in relevant, contextual material. This may be better judged by peers than consultants. Research to assess sustained educational impact, benefits to peer teachers, and economic advantages of this approach would further enhance the application of this developing model in postgraduate clinical education.
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