What do Japanese residents learn from treating dying patients? The implications for training in end-of-life care

Arai, Kozo; Saiki, Takuya; Imafuku, Rintaro; Kawakami, Chihiro; Fujisaki, Kazuhiko; Suzuki, Yasuyuki

doi:10.1186/s12909-017-1029-6

Cited by 16 publications

(15 citation statements)

References 26 publications

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“…In particular, it is natural that they felt anxious and fearful in taking care of terminally ill patients at potential risk of death. This finding in this study is congruent with that of a study by Arai et al, 33 who investigated the emotions of residents taking care of dying patients in general hospitals. They argue that the residents' emotional state was negatively affected by not only the reality of patient death but also their relationship with their supervisors who were biomedically oriented.…”

Section: Discussionsupporting

confidence: 93%

Experiential learning of overnight home care by medical trainees for professional development: an exploratory study

et al. 2020

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Objectives: In an ageing society, community-based medical education in a home care setting needs to be developed. Drawing on Kolb's experiential learning theory, this study aimed to explore the learning processes in overnight home care by medical trainees in terms of their understanding of terminally ill patients and their conceptualization of themselves as future physicians. Methods: An overnight home care program in which a trainee had to take care of terminally ill patients on his/her own under the supervision of a healthcare team was conducted. Nineteen trainees, including eight medical students and 11 residents, participated in this study. Text data of reflective reports written after the overnight care were collected and thematically analyzed. Results: The trainees' learning experiences in the program were categorized into four stages: predeparture, concrete experience, reflective observation and abstract conceptualization. Although they had mixed feelings, including anxiety, fear and expectations, at the predeparture stage, they could be actively involved in providing medical care and daily life support and in taking care of dying patients at the patients' homes overnight. By reflecting on their experiences, they gained a sense of achievement and identified the aspects upon which they should improve as future physicians. Subsequently, based on their reflective observation, they conceptualized their approaches to home care and the roles/responsibilities of physicians as healers, which led to professional identity formation. Conclusions: Overnight home care by medical trainees has the potential as an educational strategy to promote their realistic understanding of home care and facilitate professional identity formation.

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Section: Discussionsupporting

confidence: 93%

Experiential learning of overnight home care by medical trainees for professional development: an exploratory study

et al. 2020

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“…Considering this challenge, it is understandable that laypeople are more likely to harbour a stereotyped understanding of EoL and stigma around death compared to healthcare students or professionals. However, this study suggests that constructing stories enables lay participants to recognise their perception of the EoL and reflect on their own experience and feelings, similar to healthcare professionals (Arai et al, 2017). Narratives evoked participants' feelings and induced a catharsis of emotions after they expressed and verbalised these feelings.…”

Section: Discussionmentioning

confidence: 75%

How and what do laypeople learn about end-of-life care using narrative? A case study in educational research

Haruta

Oishi

Den³

2020

TAPS

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Background: Studies have reported positive impacts from community engagement in end-of-life (EoL) care. However, few studies have used a narrative for health promotion. Thus, we examined how and what lay participants learned through an EoL care education program using narrative. Methods: A case study in educational research was implemented through qualitative process evaluation. The program was conducted in a hospital in Japan. Participants living in the surrounding community were recruited by convenience sampling. We conducted 90-minute focus groups with participants at two and eight months after the completion of the program. All data were audio-recorded, transcribed verbatim, and analysed using thematic analysis. Result: We identified five themes. First, participants reconstructed the concept of EoL care using their own experience and new knowledge gained in the program. Second, the stories in the program stimulated participants to recall their feelings and emotions, which caused catharsis effects. Third, the stories evoked other perspectives through metacognition. Fourth, their experience inspired altruism towards patients and their families at the EoL. Fifth, they reflected on their own deaths as an extension of their relationship with others. This learning process was consistent with Kolb's experiential learning. Their experience enabled lay participants to overcome the existential terror of death while using the narrative mode of thinking to perceive their relationship with others as a symbolic identity. Conclusion: The educational program using narrative deepened lay participants' understanding of the concept of EoL care. Such programs have the potential to enhance community engagement in EoL care.

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“…However, there are studies that contradict this idea and show that medical students do benefit from early teaching of EOL care, not only to better treat dying patients, but patients in general [40, 41]. On the other hand, as mentioned by our respondents and in another study with resident participants, it was their personal experience with EOL care that taught them positive strategies they later applied in practice [42]. Additionally, although residents consider that psychotherapy would be helpful, they are not interested in seeking external professional help.…”

Section: Discussionmentioning

confidence: 94%

Experience of oncology residents with death: a qualitative study in Mexico

et al. 2019

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BackgroundPhysicians play a fundamental role in the care of patients at the end of life that includes knowing how to accompany patients, alleviate their suffering and inform them about their situation. However, in reality, doctors are part of this society that is reticent to face death and lack the proper education to manage it in their clinical practice. The objective of this study was to explore the residents’ concepts of death and related aspects, their reactions and actions in situations pertaining to death in their practice, and their perceptions about existing and necessary training conditions.MethodsA qualitative approach was used to examine these points in depth based on interviews conducted with seven oncology residents.ResultsParticipants do not have a clear concept of death and, although it is seen as a common phenomenon, they consider it an enemy to beat. The situations to which respondents react more frequently with frustration and sadness after the death of patients were when they felt emotionally involved, if they identify with the patient, in cases of pediatric patients and with patients who refuse treatment. To deal with death, participants raise barriers and attempt to become insensitive. Although residents in this study recognize the importance of training to learn how to better deal with death, it seems they are not fully invested in reaching more of it.ConclusionsParticipants face death in a daily basis without the necessary training, which appears to impact them more than they are willing to accept. They do not achieve their goals managing situations regarding death as well as they assume they do. Despite recognizing the need of more training and support for better coping with death, they prefer to continue to learn from their experience.Trial registrationNot applicable.

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What do Japanese residents learn from treating dying patients? The implications for training in end-of-life care

Cited by 16 publications

References 26 publications

Experiential learning of overnight home care by medical trainees for professional development: an exploratory study

Experiential learning of overnight home care by medical trainees for professional development: an exploratory study

How and what do laypeople learn about end-of-life care using narrative? A case study in educational research

Experience of oncology residents with death: a qualitative study in Mexico

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