Journal of palliative medicine
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Resident physicians are inadequately taught how to communicate with patients about end-of-life decision making. Their beliefs about resuscitation and prior experiences with end-of-life care may impact the manner in which they approach patients. ⋯ Residents report internal conflict about their experiences discussing resuscitation with patients. Their approach to these discussions focuses on resuscitation itself with less attention paid to processes that might improve patient decision making. The challenges they describe may be overcome with improved education about end-of-life communication.
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Dyspnea, a common distressing end-of-life symptom, is treated with oral (i.e., opioids and anxiolytics) and inhaled medications (anti-inflammatory and bronchodilator agents). Health care providers and patients have demonstrated an inability to use inhaler devices correctly, which can lead to suboptimal drug delivery and poor symptom relief. Hospice nurses are the primary health care providers educating patients, making it critical that they convey accurate device technique. ⋯ Years of experience, presence of hospice certification, personal use of inhaler, and nursing comfort level significantly impacted ability to use inhalation devices. This study demonstrated the existence of knowledge gaps regarding patient assessment, pharmacology and pharmacokinetics of inhaled medications, and inhalation device technique among hospice nurses. Formal education of hospice practitioners regarding inhaled medications and inhalation delivery devices is needed.
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As a newly recognized subspecialty, the field of hospice and palliative medicine (HPM) must transition existing pathways for board certification, fellowship standards, and fellowship accreditation to one based on the Accreditation Council for Graduate Medical Education and American Board of Medical Specialties competency framework. The Competencies Work Group of the American Board of Hospice and Palliative Medicine, using an iterative process informed by the field, has developed a set of Initial Competency-based Outcomes for the HPM Subspecialist. These competencies will set the standard for the "competent hospice and palliative medicine subspecialist physician," guiding future HPM fellowship training and potential midcareer HPM training opportunities. Lessons learned are highlighted.