Education in End-of-Life Care: What Do Experienced Professionals Find Important?

Abstract

End-of-life care is an essential element of quality cancer care. Nevertheless, a majority of physicians and nurses working at cancer centers feel unprepared for this task. As part of a larger survey study, we investigated what suggestions experienced physicians and nurses have to improve education/training on end-of-life care. In an open question, participants were requested to suggest changes to the end-of-life curriculum for physicians and nurses. Answers to this question were content analyzed using the qualitative data analysis software MAXQDA. Physicians and nurses at 10 cancer centers throughout Baden-Wuerttemberg were surveyed. From the total 1131 survey participants, 675 (483 nurses, 167 physicians, 25 unknown) responded to the open question regarding suggestions for education/training in end-of-life care. Two main categories were inductively developed: (1) format (i.e., structure and method of teaching) and (2) content (i.e., knowledge and know-how required for care of the dying). Regarding format, both professional groups most often wished for more practical experiences with dying patients (e.g., internships at hospices). Regarding content, physicians and nurses most frequently requested (1) more basic information on palliative care, (2) increased skills training in communication, and (3) knowledge of how to appropriately care for patients' caregivers. The results of our analysis reflect already trained physicians' and nurses' interest in furthering their knowledge and skills to care for dying patients. The suggestions of experienced physicians and nurses should be integrated into the further development of palliative care curricula.

Opinions of nursing and medical students before the end of their university education on their preparation for work with the dying patient

“…A positive assessment was given by 62.5% (n=70) of the their own emotions in the face of the patient's death, to communicate with the dying patient or provide care to and cooperate with the patient's family. Similar results were obtained by Jors et al [11] in a group of physicians and nurses working at cancer care centres. They reported a need for knowledge and skills in the field of basic palliative care, end-of-life patient communication, and cooperation/interaction with the dying patient's family.…”

“…Research reports show that not only nursing and medical students, but also professionally active nurses and physicians do not consider themselves adequately prepared to provide care to dying patients. This is evidenced by opinions shared by physicians and nurses as well as by patients and their families [4,6,[8][9][10][11]. One must realise that the process of dying and death is special and, at the same time, difficult for the patients and their families on the one hand, but, on the other hand, for the medical staff as well.…”

Death talk: Basic linguistic rules and communication in perinatal and paediatric end-of-life discussions

“…The quality of communication is greatly affected by the limited time healthcare professionals have at their disposal; the personal challenge health care professionals themselves face when dealing with parents also seems to play a role [14,15], and, importantly, there is a lack of sustained training in communication [12,14]. The focus of doctors' training has traditionally primarily been on the technical aspects of treatment and the preservation of life.…”

“…A "Please keep parents informed. It seems a constant uphill struggle to obtain information, particularly in the hours immediately after delivery or transfer [15]." 1.…”

“…Violation of the first part of this maxim is evident in the described struggle to access information (1A), the sense that doctors were withholding details (1B), the isolation created by a lack of healthcare professionals to provide answers (1C) and the need to secure time with doctors (1D A "Be honest with parents and don't be scared of telling the truth. People cope-they don't have a choice [15]." 1.…”