The Palliative Care Clinical Evaluation Exercise (CEX): An Experience-Based Intervention for Teaching End-of-Life Communication Skills

Han, Paul K. J.; Keränen, Lisa; Lescisin, Dianne A; Arnold, Robert M.

doi:10.1097/00001888-200507000-00009

Cited by 55 publications

(40 citation statements)

References 38 publications

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“…The ability of health care professionals to communicate difficult messages effectively can be learned through directed education and practice. [29][30][31][32][33][34][35] 6. Family Support PPC-PHC clinicians should aim to partner with and support parents throughout the course of the child's illness experience.…”

Section: Communication and Decision Supportmentioning

confidence: 99%

Pediatric Palliative Care and Hospice Care Commitments, Guidelines, and Recommendations

Jewell¹,

Friebert²,

Carter³

et al. 2013

Pediatrics

382

101

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Pediatric palliative care and pediatric hospice care (PPC-PHC) are often essential aspects of medical care for patients who have life-threatening conditions or need end-of-life care. PPC-PHC aims to relieve suffering, improve quality of life, facilitate informed decision-making, and assist in care coordination between clinicians and across sites of care. Core commitments of PPC-PHC include being patient centered and family engaged; respecting and partnering with patients and families; pursuing care that is high quality, readily accessible, and equitable; providing care across the age spectrum and life span, integrated into the continuum of care; ensuring that all clinicians can provide basic palliative care and consult PPC-PHC specialists in a timely manner; and improving care through research and quality improvement efforts. PPC-PHC guidelines and recommendations include ensuring that all large health care organizations serving children with life-threatening conditions have dedicated interdisciplinary PPC-PHC teams, which should develop collaborative relationships between hospital-and community-based teams; that PPC-PHC be provided as integrated multimodal care and practiced as a cornerstone of patient safety and quality for patients with life-threatening conditions; that PPC-PHC teams should facilitate clear, compassionate, and forthright discussions about medical issues and the goals of care and support families, siblings, and health care staff; that PPC-PHC be part of all pediatric education and training curricula, be an active area of research and quality improvement, and exemplify the highest ethical standards; and that PPC-PHC services be supported by financial and regulatory arrangements to ensure access to high-quality PPC-PHC by all patients with life-threatening and life-shortening diseases. Pediatrics 2013;132:966-972 INTRODUCTIONOver the past two decades, pediatric palliative care has emerged as an established field of medical expertise and practice. [1][2][3] Recognized in 2006 by the American Board of Medical Specialties, hospice and palliative medicine is the field of medical expertise that seeks to improve quality of life and reduce various forms of distress for patients and their families in the face of serious life-threatening or inevitably lifeshortening conditions or when end-of-life care or bereavement services are needed. Pediatric palliative care addresses the needs of infants, children, adolescents, and young adults (subsequently referred to SECTION collectively as "children") with these conditions and the needs of their families, providing treatments that aim to (1) relieve suffering across multiple realms, including the physical (eg, pain or dyspnea), psychological (depression, anxiety, or sense of guilt), social (isolation), practical (home-based services or financial stress), and existential or spiritual (why is this happening?); (2) improve the child' s quality and enjoyment of life while helping families adapt and function during the illness and through bereavement; (3) f...

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Section: Communication and Decision Supportmentioning

confidence: 99%

Pediatric Palliative Care and Hospice Care Commitments, Guidelines, and Recommendations

Jewell¹,

Friebert²,

Carter³

et al. 2013

Pediatrics

382

101

View full text Add to dashboard Cite

show abstract

“…Effective strategies to teach communication skills in goals of care and DNR discussions involve experiential learning. These include direct observation and feedback of residents by palliative care clinicians during real-life code status discussions, 70 using of audio-visual triggers and role plays, 71,72 and standardized patient exercises. 73,74 Additionally, teaching skills in breaking bad news and managing family conflicts are also important to prepare future providers to assist patients and families navigate through the complex and difficult decisions surrounding resuscitation decisions.…”

Section: Text Box 2 Proposed Joint Commission Standards For Dnr Discmentioning

confidence: 99%

Hospital Do-Not-Resuscitate Orders: Why They Have Failed and How to Fix Them

2011

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Do-not-resuscitate (DNR) orders have been in use in hospitals nationwide for over 20 years. Nonetheless, as currently implemented, they fail to adequately fulfill their two intended purposes-to support patient autonomy and to prevent non-beneficial interventions. These failures lead to serious consequences. Patients are deprived of the opportunity to make informed decisions regarding resuscitation, and CPR is performed on patients who would have wanted it withheld or are harmed by the procedure. This article highlights the persistent problems with today's use of inpatient DNR orders, i.e., DNR discussions do not occur frequently enough and occur too late in the course of patients' illnesses to allow their participation in resuscitation decisions. Furthermore, many physicians fail to provide adequate information to allow patients or surrogates to make informed decisions and inappropriately extrapolate DNR orders to limit other treatments. Because these failings are primarily due to systemic factors that result in deficient physician behaviors, we propose strategies to target these factors including changing the hospital culture, reforming hospital policies on DNR discussions, mandating provider communication skills training, and using financial incentives. These strategies could help overcome existing barriers to proper DNR discussions and align the use of DNR orders closer to their intended purposes of supporting patient selfdetermination and avoiding non-beneficial interventions at the end of life.KEY WORDS: do-not-resuscitate orders; informed consent; end-of-life care.

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“…Medical curricula with focused, hands on, patient communication training have been shown to improve patient-physician interactions [13,14]. Indeed, standardized education tools such as rubrics have been created and utilized with some success for communication in specific clinical contexts, including palliative care [15]. Implementation of similar models for communication in other clinical areas, such as gynecology and family practice, may contribute to improved patient care.…”

Section: Discussionmentioning

confidence: 99%

Identification of Patient-Perceived Barriers to Communication between Patients and Physicians

Douglas¹,

Souza²,

Yudin³

2017

Fam Med Med Sci Res

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Purpose: Barriers to full disclosure and communication of complete and accurate health history from patients to their physicians can compromise patient care. Identification of barriers to communication between patients and their physicians, and assessing communication techniques to overcome putative barriers may improve medical training, quality patient care, and patient experience. Methods:The authors performed a cross-sectional study using a novel questionnaire at an urban, inner-city hospital in Toronto, Ontario between January 1, 2011 and January 1, 2012, in order to evaluate potential barriers to communication. Variables included physician age, gender, education, ethnicity, position, perceived sexual orientation, marital status, physical attractiveness and reason for appointment. All patients attending a gynaecology appointment received the paper-based, anonymous questionnaire. Analyses applied the statistical package, SAS Software, Version 9.2. Results:Responses for 286 completed questionnaires were analysed. The most common barriers to communication included having a male physician (40.9%) and having a history taken by a medical student (24.5%). Sensitivity to having a male provider was more frequently reported in women under the age of thirty (63.6%) and nulliparous women (49.6%), p<0.05. Communication was perceived to be improved when physicians acknowledged patient concerns (95.1%), sought to understand patient concerns (91.9%), and included the patient in decisionmaking (74.1%). Conclusions:Physician gender and education level are barriers to full disclosure and communication from patients. Physicians should strive to understand patient concerns and include patients in decision-making in order to encourage full disclosure. Awareness of these obstacles is vital to promoting patient-centered care and to effective physician training.

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The Palliative Care Clinical Evaluation Exercise (CEX): An Experience-Based Intervention for Teaching End-of-Life Communication Skills

Abstract: The Palliative Care CEX is feasible and positively valued by residents. The findings from this initial pilot study support the value of further efforts to refine the intervention, to confirm its feasibility in other settings, and to validate its use as an educational and assessment tool.

Cited by 55 publications

References 38 publications

Pediatric Palliative Care and Hospice Care Commitments, Guidelines, and Recommendations

Pediatric Palliative Care and Hospice Care Commitments, Guidelines, and Recommendations

Hospital Do-Not-Resuscitate Orders: Why They Have Failed and How to Fix Them

Identification of Patient-Perceived Barriers to Communication between Patients and Physicians

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