Palliative Care Always: Hepatology—Virtual Primary Palliative Care Training for Hepatologists

DeNofrio, Jan C.; Kosinski, Andrzej S.; Navarro, Victor J.; Taddei, Tamar H.; Volk, Michael L.; Bakitas, Marie; Ramchandran, Kavitha

doi:10.1002/hep4.1849

Cited by 11 publications

(6 citation statements)

References 36 publications

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“…As mentioned above, the EAPC recommends using digital learning to enhance understanding of PC theory and its application to practice [10]. E-learning or blended courses to teach PC subjects are offered [26] and evaluated worldwide [27,28]. However, few data evaluate gains in crucial competencies for providing PC, such as knowledge, attitude, or communication skills [28,29].…”

Section: Discussionmentioning

confidence: 99%

Palliative Care e-Learning for Physicians Caring for Critically Ill and Dying Patients during the COVID-19 Pandemic: An Outcome Evaluation with Self-Assessed Knowledge and Attitude

Schwartz

Schallenburger

Tenge

et al. 2022

IJERPH

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During the COVID-19 pandemic, the care of critically ill and dying patients in isolation wards, intensive care units (ICUs), and regular wards was severely impaired. In order to support physicians in communicative and palliative care skills, an e-learning tool was developed as part of the joint project “Palliative Care in Pandemic Times” (PallPan). This study investigates the feasibility of this e-learning tool. Secondly, we aim to analyze changes in knowledge and attitude upon completion of the e-learning tool. A 38-item questionnaire-based evaluation study with assessment of global and specific outcomes including ICU and non-ICU physicians was performed. In total, 24 questionnaires were included in the anonymous analysis. Feasibility was confirmed by a very high rate of overall satisfaction (94% approval), with relevance reaching 99% approval. Overall, we detected high gains in knowledge and noticeably lower gains on the attitude plane, with the highest gain in naming reasons for incorporating palliative care. The lowest learning gain on the attitude plane was observed when the participants were confronted with their own mortality. This study shows that e-learning is a feasible tool for gaining knowledge and even changing the attitudes of physicians caring for critically ill and dying patients in a self-assessment evaluation.

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Section: Discussionmentioning

confidence: 99%

Palliative Care e-Learning for Physicians Caring for Critically Ill and Dying Patients during the COVID-19 Pandemic: An Outcome Evaluation with Self-Assessed Knowledge and Attitude

Schwartz

Schallenburger

Tenge

et al. 2022

IJERPH

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“…Both models have demonstrated feasibility with current enrollment of more 700 patients and 460 caregivers across the network of 17 clinical centers. The PC training program for hepatologists has proved to improve knowledge and self‐efficacy to deliver primary PC 61. How this knowledge translates to better patient outcomes will be assessed; in addition, sustainability of both models will further inform the field for next steps.…”

Section: Element #5: Integrate Palliative Care Delivery Within Routin...mentioning

confidence: 99%

“…The PC training program for hepatologists has proved to improve knowledge and self-efficacy to deliver primary PC. [61] How this knowledge translates to better patient outcomes will be assessed; in addition, sustainability of both models will further inform the field for next steps. It remains challenging when to integrate PC for patients with cirrhosis; either MELD scores or PRO scores can be utilized to trigger PC consults.…”

Section: Hepatologymentioning

confidence: 99%

Patient‐centered care: Key elements applicable to chronic liver disease

et al. 2022

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Chronic liver disease (CLD) is a progressive illness with high symptom burden and functional and cognitive impairment, often with comorbid mental and substance use disorders. These factors lead to significant deterioration in quality of life, with immense burden on patients, caregivers, and healthcare. The current healthcare system in the United States does not adequately meet the needs of patients with CLD or control costs given the episodic, reactive, and fee-for-service structure. There is also a need for clinical and financial accountability for CLD care. In this context, we describe the key elements required to shift the CLD care paradigm to a patient-centered and value-based system built upon the Porter model of value-based health care. The key elements include (1) organization into integrated practice units, (2) measuring and incorporating meaningful patientreported outcomes, (3) enabling technology to allow innovation, (4) bundled care payments, (5) integrating palliative care within routine care, and (6) formalizing centers of excellence. These elements have been shown to improve outcomes, reduce costs, and improve overall patient experience for other chronic illnesses and should have similar benefits for CLD. Payers need to partner with providers and systems to build upon these elements and help align reimbursements with patients' values and outcomes. The national organizations such as the American Association for Study of Liver Diseases need to guide key stakeholders in standardizing these elements to optimize patient-centered care for CLD.

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“…There is an increasing focus on educating trainees about palliative and supportive care which is now included in most registrar curricula at least at the basic level. Online training is available for those with an interest 39. It would appear self evident that conversations with patients in relation to their prognosis and their wishes take place but sadly this does not always happen given working patterns within hospitals.…”

Section: Reasons To Be Optimisticmentioning

confidence: 99%

Symptom control in advanced chronic liver disease: integrating anticipatory palliative and supportive care

Wright

Woodland

Hudson

2022

Frontline Gastroenterol

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The number of patients coming to hospital with liver disease is increasing. There was a worrying trend before the pandemic, and this has intensified. Despite improvements in the management of patients with advanced cirrhosis many patients will die within 6–12 months of first presentation, and, despite this, the field of palliative and supportive care in liver disease is still in its infancy. This is a narrative review. Evidence is often thin in this field. Where it exists it is cited, but much of the commentary here is based on the authors own experience and readers are free to consider it and debate it. Most patients who die of liver disease receive palliative care very late in their illness (if at all). There are many barriers to supportive and palliative care in liver disease which are discussed. Symptom control is often poor because of these barriers. Before symptomatic control can be established, patients in need of it must to be identified and conversations had about the severity of their situation and what their wishes would be. Interest in palliative and supportive care for patients liver disease is growing as is the number of hepatologists and palliative care clinicians within the UK with an interest. It is important that this enthusiasm and interest can be rolled out and scaled up across the UK so that all patients, wherever they are, can benefit. The aims of these articles are first to highlight and bring into focus the unmet need for palliative and supportive care in liver disease and second to provide suggestions for its integration into liver services. Ask yourself the question: where would I start in my hospital to help these patients?

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Palliative Care Always: Hepatology—Virtual Primary Palliative Care Training for Hepatologists

Cited by 11 publications

References 36 publications

Palliative Care e-Learning for Physicians Caring for Critically Ill and Dying Patients during the COVID-19 Pandemic: An Outcome Evaluation with Self-Assessed Knowledge and Attitude

Palliative Care e-Learning for Physicians Caring for Critically Ill and Dying Patients during the COVID-19 Pandemic: An Outcome Evaluation with Self-Assessed Knowledge and Attitude

Patient‐centered care: Key elements applicable to chronic liver disease

Symptom control in advanced chronic liver disease: integrating anticipatory palliative and supportive care

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