Simulation training in palliative care: state of the art and future directions

Abstract

BackgroundThe growing need for palliative care (PC) among patients with serious illness is outstripped by the short supply of PC specialists. This mismatch calls for competency of all health care providers in primary PC, including patient-centered communication, management of pain and other symptoms, and interprofessional teamwork. Simulation-based medical education (SBME) has emerged as a promising modality to teach key skills and close the educational gap. This paper describes the current state of SBME in training of PC skills.MethodsWe conducted a systematic review of the literature reporting on simulation experiences addressing PC skills for clinical learners in medicine and nursing. We collected data on learner characteristics, the method and content of the simulation, and outcome assessments.ResultsIn a total of 78 studies, 76% involved learners from medicine and 38% involved learners from nursing, while social work (6%) and spiritual care (3%) learners were significantly underrepresented. Only 16% of studies involved collaboration between participants at different training levels. The standardized patient encounter was the most popular simulation method, accounting for 68% of all studies. Eliciting treatment preferences (50%), delivering bad news (41%), and providing empathic communication (40%) were the most commonly addressed skills, while symptom management was only addressed in 13% of studies. The most common method of simulation evaluation was subjective participant feedback (62%). Only 4% of studies examined patient outcomes. In 22% of studies, simulation outcomes were not measured at all.DiscussionWe describe the current state of SBME in PC education, highlighting advances over recent decades and identifying gaps and opportunities for future directions. We recommend designing SBME for a broader range of learners and for interprofessional skill building. We advocate for expansion of skill content, especially symptom management education. Finally, evaluation of SBME in PC training should be more rigorous with a shift to include more patient outcomes.

Insights from a community-based palliative care course: a qualitative study

“…The authenticity of the situations contrasted with the usual medical school experience. Although simulations with actors are a good strategy for those who have only limited opportunities to experience real end-of-life situations [ 23 ], there is no comparison with ‘real’ patient contact – especially with patients at the end of life. A [the letter does not represent a single student]: (...) In the ‘Palli-block’ [mandatory PC course], in 7th semester [3rd year], I think you get good insights, but that is a huge difference to actually meeting a patient in the real situation.…”

“…The authenticity of the situations contrasted with the usual medical school experience. Although simulations with actors are a good strategy for those who have only limited opportunities to experience real end-of-life situations [23], there is no comparison with 'real' patient contactespecially with patients at the end of life.…”

TRIAD XI: Utilizing simulation to evaluate the living will and POLST ability to achieve goal concordant care when critically ill or at end‐of‐life—The Realistic Interpretation of Advance Directives

“…Most of the LW and POLST research evaluates whether the patient died however, no research prior to TRIAD evaluates whether or not the care was correct or concordant with the patient's wishes and informed consent. Similarly, simulation is utilized in EOL care research to teach how to have an EOL discussion but does not evaluate the provider response to the LW or POLST to evaluate provider competency 20 . This simulation study is different with respect to two issues.…”

Pancreatic cancer—A disease in need: Optimizing and integrating supportive care

“…Over the past decade, palliative care education has been systematically integrated into medical education and has become a standardized competency for medical training . Simulation‐based medical education with standardized patients has emerged as a promising modality to teach key palliative care skills and close the education gap . In the VOICE trial (Values and Options in Cancer Care), patient‐centered communication about advanced cancer diagnosis, treatment options, prognosis, and QoL was enhanced with individualized training for both the clinician and the patient …”

“…10 Simulation-based medical education with standardized patients has emerged as a promising modality to teach key palliative care skills and close the education gap. 11,12 In the VOICE trial (Values and Options in Cancer Care), patient-centered communication about advanced cancer diagnosis, treatment options, prognosis, and QoL was enhanced with individualized training for both the clinician and the patient. 13 Another standardized process is the implementation of supportive care screening tools for patients with PDAC.…”