Journal of palliative medicine
-
Introduction: The National Institute for Health and Care Excellence (NICE) recommends an individualized approach to end-of-life care (EOLC), including an individualized record of care, which supports shared decision-making and timely rationalization of futile observations and medications. Aim: To assess the impact of the individualized record of care in supporting patients at the end of life at a UK tertiary cancer center. Method: In May 2024, we audited the case notes of 100 consecutive patients who received EOLC at our center. ⋯ Evidence of discussion about rationalization of observations and medications was present in approximately half of the case notes and often occurred after the rationalization had taken place. Conclusion: The presence of an individualized end-of-life record of care improved rates of review and rationalization of observations and medications. Future qualitative work is needed to identify challenges regarding these conversations, including examining the role of shared decision-making on rationalization versus patients' refusal.
-
Background: Early advance care planning (ACP) is associated with improved outcomes in pediatrics, yet few rigorously developed curricula exist to train interprofessional clinicians in ACP communication. Objectives: To develop, pilot and evaluate an evidence-based virtual clinician training in a pediatric serious illness communication program (PediSICP) to facilitate ACP. Primary outcomes were learner self-assessment of skills attainment and training program satisfaction. ⋯ Additionally, clinician self-reported comfort discussing fundamental elements of ACP significantly increased following the training. Conclusion: Teaching ACP communication virtually to pediatric interprofessional clinicians is both feasible and acceptable, with improvements described in self-reported knowledge and comfort discussing elements of ACP. Future research will test the efficacy of PediSICP to facilitate longitudinal ACP.
-
Context: The growing field of palliative care emphasizes the need for high-quality research, yet the contributions of nonphysician palliative care specialists to studying patient outcomes remain underexplored. Methods: This national observational study aims to identify barriers to conducting research among chaplains, nurses, pharmacists, and social workers in palliative care settings. An anonymous online survey was conducted across various disciplines. ⋯ Nurse practitioners and social workers reported lower research involvement and higher perceived barriers in study design and mentorship. Conclusion: The study highlights the need for tailored interventions, including targeted training, mentorship, and financial support to enhance research engagement among nonphysician palliative care specialists. Addressing these barriers through institutional support and interprofessional collaboration is crucial for advancing palliative care research and practice.