End-of-Life Training in US Internal Medicine Residency Programs: A National Study

Background: End-of-life care is a required and important component of medical training for internal medicine residents; many of whom will go on to provide care for adults at the end-of-life stage. Although a body of past research suggests that physician training in end-of-life care needs significant improvement, a comprehensive national study of end-of-life education within US internal medicine residency programs has never been published. Objective: To determine the status of end-of-life education in internal medicine residency programs in the United States. Method: The study was a cross-sectional, observational study of all internal medicine Residency Program Directors in the US as of May 2015. Postal mail and email were used to disseminate a multi-wave survey to program directors. Results: More than half (52%) of all program directors completed the survey. Although directors strongly believed in the benefits of residents integrating end-of-life care components into clinical practice, only 36% of programs reported having formal end-of-life curriculum in place for more than three years. Of those programs that taught end-of-life topics or skills, the majority did not formally evaluate residents’ competence. Moreover, 24% of residency programs did not have an end-of-life curriculum; 34% did not offer a rotation in hospice care; and 31% did not have structured conference teaching on topics dealing with end-of-life. Conclusions: Although end-of-life training of physicians has improved over the years, deficiencies remain within US internal medicine residency programs

Using the consolidated framework for implementation research to identify church leaders’ perspectives on contextual determinants of community-based colorectal cancer screening for Black Kentuckians

Abstract Background Black Kentuckians experience more deleterious colorectal cancer (CRC) outcomes than their White counterparts, a disparity that could be reduced by increased screening in Black communities. Previous research has shown that Black Kentuckians may not be equitably informed of different CRC screening options by health care providers, making community-based screening a potentially effective option among this disparate population. We used the Consolidated Framework for Implementation Research (CFIR) to identify church leaders’ perspectives of contextual factors that might influence community-based screening and explore the feasibility of using church-based screening outreach. Methods Six participants were selected, based on leadership roles and interest in CRC screening, from five established Louisville-area church partners that had previously participated in community health initiatives. Data were collected, both virtually and in-person, in Summer 2021 using semi-structured interview guides developed with guidance from the CFIR Guide that focused on domains most relevant to community-based interventions. Data were transcribed verbatim, coded by two independent researchers, and member checked for accuracy. Results Data were aligned primarily with six CFIR constructs: key stakeholders, champions, opinion leaders, tension for change, compatibility, and culture. Participants noted a strong tension for change in their community due to perceptions of inadequacy with clinical approaches to CRC screening. Additionally, they stressed the importance of identifying individuals both within the church who could champion CRC screening and help implement program activities, as well as those outside the church who could collaborate with other local organizations to increase participant reach. Finally, participants agreed that faith-based CRC screening aligned with church culture and would also likely be compatible with overall community values. Conclusions Overall, our church partners strongly endorsed the need for, and importance of, community-based CRC screening. Given a history of successful implementation of health promotion programs within our partner churches, it is highly likely that a CRC screening intervention would also be effective. Findings from this study will be used to identify implementation strategies that might positively impact a future faith-based CRC screening intervention, as well as CFIR constructs that are most positively associated with CRC screening completion

Feasibility and efficacy of a novel audiovisual tool to increase colorectal cancer screening among rural Appalachian Kentucky adults

IntroductionResidents of Appalachian regions in Kentucky experience increased colorectal cancer (CRC) incidence and mortality. While population-based screening methods, such as fecal immunochemical tests (FITs), can reduce many screening barriers, written instructions to complete FIT can be challenging for some individuals. We developed a novel audiovisual tool (“talking card”) to educate and motivate accurate FIT completion and assessed its feasibility, acceptability, and efficacy.Materials and methodsWe collected data on the talking card via: (1) cross-sectional surveys exploring perceptions of images, messaging, and perceived utility; (2) follow-up focus groups centered on feasibility and acceptability; and (3) efficacy testing in community-based FIT distribution events, where we assessed FIT completion rate, number of positive vs. negative screens, demographic characteristics of participants, and primary drivers of FIT completion.ResultsAcross the three study phases, 692 individuals participated. Survey respondents positively identified with the card’s sounds and images, found it highly acceptable, and reported high-to-very high self-efficacy and response efficacy for completing FIT, with nearly half noting greater likelihood to complete screening after using the tool. Focus group participants confirmed the acceptability of the individuals featured on the card. Nearly 75% of participants provided a FIT accurately completed it, with most indicating the talking card, either alone or combined with another strategy, helped with completion.DiscussionTo reduce CRC screening disparities among Appalachian Kentuckians, population-based screening using contextually relevant implementation strategies must be used alongside clinic-based education. The talking card represents a novel and promising strategy to promote screening uptake in both clinical and community settings