Abstract:Background: Framing is known to influence decision making. Objective: The study objective was to describe language used by physicians when discussing treatment options with a critically and terminally ill elder. Methods: High-fidelity simulation was used, involving an elder with end-stage cancer and life-threatening hypoxia, followed by a debriefing interview. Subjects were hospitalist, emergency medicine, and critical care physicians from three academic medical centers. Measures were observation of encounters… Show more
“…Indeed, the language used to frame treatment options has been shown to influence treatment decisions. 25 This finding is also consistent with a prior study that found that a high-intensity medical center, compared with a lower intensity facility, was more likely to offer open-ended trials of life-sustaining treatments without addressing long-term goals. 26 Our study has several limitations.…”
Medical record documentation suggests that inappropriate treatment occurs in the setting of communication and decision-making patterns that may be amenable to intervention.
“…Indeed, the language used to frame treatment options has been shown to influence treatment decisions. 25 This finding is also consistent with a prior study that found that a high-intensity medical center, compared with a lower intensity facility, was more likely to offer open-ended trials of life-sustaining treatments without addressing long-term goals. 26 Our study has several limitations.…”
Medical record documentation suggests that inappropriate treatment occurs in the setting of communication and decision-making patterns that may be amenable to intervention.
“…A third study included hospitalist, EM, and critical care physicians in a technologically advanced robotic simulation with a family member of a critically ill patient. Participants broached life-sustaining treatment differently than treatment focusing on comfort, commonly framing life-sustaining treatment as necessary while framing comfort measures as optional 42. These studies demonstrate that SBME allows researchers to investigate communication behaviors in a standardized setting that does not interfere with patient care.…”
Section: Discussionmentioning
confidence: 95%
“…SBME is a useful method to study and teach provider communication behaviors because it allows researchers to replicate particular clinical scenarios in ways not possible in real patient encounters. Several studies investigated the language used in discussions with patients, as well as how treatment options were framed 40–42…”
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.
“…Training in these competencies may improve nursing professionals’ attitudes toward end-of-life care [4], their levels of anxiety [5], and even the decision-making skills of patients and their families [6].…”
The aim of the present study is to validate the Self-Efficacy in Palliative Care Scale (SEPC) in Spanish nursing professionals and students, to describe their levels of self-efficacy, and to determine the influencing factors. A validation study and a cross-sectional descriptive study were carried out, with the data analysed using contrast tests and multiple linear regression; 552 nurses and 440 nursing students participated. The Spanish version consists of 23 items and has a high degree of reliability (α = 0.944). Confirmatory factor analysis revealed one additional factor (i.e., management of psychosocial and spiritual aspects) in comparison to the original scale. Contrast tests revealed that the mean SEPC score was higher in professionals than in students (p < 0.001) and that the professionals who had higher levels of self-efficacy were older (p < 0.001), had more previous training (p < 0.001), and had more experience in end-of-life care (p = 0.001). The linear analysis results confirm a significant association between age and previous training in end-of-life care. The Spanish version of the SEPC is a reliable tool for both nursing professionals and students. The level of self-efficacy of both groups is moderate and is influenced by age, experience, and training in end-of-life care.
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