\u27Workshops in healing\u27 for senior medical students: 5 year overview and appraisal

We report upon the design, content and feedback from an interactive, experiential series of Workshops in Healing for senior medical students. Fifty-six final year medical students enrolled in 2×3 h workshops designed around the core themes of ‘physician know thyself’ (Workshop 1) and ‘confronting suffering’ (Workshop 2). Of the 56 students who initially enrolled, 48 students completed both workshops and provided a written openended reflection of their learning experience. The study, undertaken over a consecutive 5-year period (2008–2012), employed an emergent, qualitative design using thematic analysis of the reflective comments. We found that the design and content of both workshops promoted transformative learning for these final year medical students. Students identified the following benefits: (1) the opportunity to reaffirm their commitment to their chosen career path; (2) the value of listening to other students share their stories; (3) the importance of the timing of the workshops to occur after exams; (4) the use of various mediums such as art, poetry, music and contemporary/classic literature to present concepts of suffering and healing; and (5) the creation of a safe and confidential space. Students reported that these innovative workshops gave them a renewed sense of drive and enthusiasm for their chosen career. They highlighted the importance of addressing an aspect of medicine (healing) not covered in the traditional medical curriculum. Workshops in Healing helped them to rediscover a deeper meaning to medicine and their roles as future healthcare professionals

The importance of translating evidence into practice in counseling individuals with life-threatening illness

A review of Counseling Individuals with Life-Threatening Illness (2nd Edition) by Kenneth J Doka. New York: Springer Publishing Company, 2013. 324 pp. (ISBN: 978-0826195814)

\u27Death is difficult in any language\u27: A qualitative study of palliative care professionals\u27 experiences when providing end-of-life care to patients from culturally and linguistically diverse backgrounds

Background: Ethnic minority patients have unique challenges in accessing health services. These include language difficulties, unfamiliarity with the health system, lower rates of cancer screening and survival, higher rates of reported side effects from cancer treatment and poorer quality of life. Little is known about this patient group when transitioning to palliative care. Aim: To elicit the experiences of palliative care health professionals when providing care for patients from culturally and linguistically diverse backgrounds which differ from mainstream Australian language and culture. Design: An emergent qualitative design, informed by theoretical and procedural direction from grounded theory research. Setting/participants: Four focus groups held with palliative care staff (n=28) in a single specialist palliative care service in Australia. Results: The following themes emerged: 1) determining the rules of engagement around discussion of diagnosis and prognosis; 2) navigating the challenge of language to patient understanding; 3) understanding migration experiences to establish trust; 4) maintaining the balance between patient safety and comfort care; 5) providing a good death experience through accommodation of beliefs; and 6) navigating the important role of family members while privileging patient preferences. Conclusion: Underlying provider perceptions of caring for patients was that death is difficult in any language. Care was conceptualised as considering cultural and linguistic backgrounds within individualistic care. Understanding the migration experience and building trust were key elements of this individualised approach. Acknowledgement of the key role played by families in patient care and safety are strategies to minimise barriers and understand the concerns of this patient group

“It is not a disease we treat, but a person”: Medical students’ reflections on their first rotations to an oncology and palliative care unit

The vast array of technologic advances in medicine has transformed traditional medical practice and education. However, these advances are not without their critics (1-7). Some medical educators and students suggest that the “final product” of medical education has many of the characteristics of the applied scientist (2) rather than those of the humane physician-healer (8). Many medical students bring to their studies an idealism and an empathy that, for many, is quickly eroded over time. According to Bellini and Shea (4), they may never fully recover their empathy. Several studies have concluded that a significant decline in empathy occurs during the third year of medical school, a time when empathy is most important because students are having their initial interactions with patients (6, 9). Shapiro has written extensively on current limitations in medical education (7, 10, 11). These include: an overemphasis on logico-scientific thinking, problem solving, and control; a devaluation of personal identity; a discounting of personal experience; and the practice of encouraging medical students to create a distance between themselves and patients. Such factors have significant implications for the way trained physicians will see their patients, for the quality of vocational satisfaction they will experience, and for their sustainability within the healthcare system (12). In 2009, the undergraduate medical curriculum at the University of New South Wales in Sydney, Australia, was expanded to include (inter alia) a significant component of reflective practice in students’ clinical activities. As a result of this curricular change, undergraduate medical students are now required to submit written reflections on their learning experiences. This compulsory report documents students’ impressions of their first four-week rotation and their exposure to patients in an oncology and palliative care setting. The aims of the current study were to analyze students’ reflections in order to determine the personal/professional impact of the rotation, to report on student responses to the new teaching curriculum, and to identify additional steps that could be taken to support students’ learning activities

The specter of cancer: Exploring secondary trauma for health professionals providing cancer support and counseling

Health professionals are vulnerable to occupational stress and tend to report high levels of secondary trauma and burnout; this is especially so for those working in “high-death” contexts such as cancer support and palliative care. In this study, 38 health professionals (psychologists, social workers, pastoral carers/chaplains, nurses, group facilitators, and a medical practitioner) who provide grief support and counseling in cancer and palliative care each participated in a semistructured interview. Qualitatively, a grounded theory analysis revealed four themes: (a) the role of health professionals in supporting people who are experiencing grief and loss issues in the context of cancer, (b) ways of working with patients with cancer and their families, (c) the unique qualities of cancer-related loss and grief experiences, and (d) the emotional demands of the work and associated self-care. The provision of psychological services in the context of cancer is colored by the specter of cancer, an unseen yet real phenomenon that contributes to secondary trauma and burnout. The participants’ reported secondary trauma has serious repercussions for their well-being and may compromise the care they provide. The findings have implications for the retention and well-being of personnel who provide psychosocial care in cancer and the quality and delivery of services for people with cancer and their families

Identifying systems barriers that may prevent bereavement service access to bereaved carers: A report from an Australian specialist palliative care service

Background: Bereavement follow up is an integral element of palliative care. However, little is known about the systems that link bereavement services with bereaved carers. Aim: To map how effectively a specialist palliative care service linked bereavement service to bereaved carers. Methodology: A retrospective medical audit, using process mapping was undertaken within one Australian specialist palliative care service to identify the systems that linked bereavement services to a consecutive cohort of palliative care decedents (n=60) next of kin. Results: Bereavement records were located for 80% of decedents. Nearly all (98%) had a nominated next of kin, with just over half (54%) of those nominated contacted by bereavement services. Incomplete or missing contact details was the main reason (75%) that the bereavement service was unable to contact the decedents’ next of kin. Conclusion: Having access to a designated bereavement service can ensure that bereaved next of kin are contract routinely and in a timely way. However the effectiveness of this type of service is dependent upon the bereavement service having access to all relevant contact information. There are numerous opportunities to refine and strengthen the recording of palliative care next of kin details to optimize follow up

The VOICE Study: Valuing Opinions, Individual Communication and Experience: Building the evidence base for undertaking patient-centred family meetings in palliative care - a mixed methods study

Background: Despite family meetings being widely used to facilitate discussion among patients, families, and clinicians in palliative care, there is limited evidence to support their use. This study aims to assess the acceptability and feasibility of Patient-Centred Family Meetings in specialist inpatient palliative care units for patients, families, and clinicians and determine the suitability and feasibility of validated outcome measures from the patient and family perspectives. Methods: The study is a mixed-methods quasi-experimental design with pre-planned Patient-Centred Family Meetings at the intervention site. The patient will set the meeting agenda a priori allowing an opportunity for their issues to be prioritised and addressed. At the control site, usual care will be maintained which may include a family meeting. Each site will recruit 20 dyads comprising a terminally ill inpatient and their nominated family member. Pre- and post-test administration of the Distress Thermometer, QUAL-EC, QUAL-E, and Patient Health Questionnaire-4 will assess patient and family distress and satisfaction with quality of life. Patient, family, and clinician interviews post-meeting will provide insights into the meeting feasibility and outcome measures. Recruitment percentages and outcome measure completion will also inform feasibility. Descriptive statistics will summarise pre- and post-meeting data generated by the outcome measures. SPSS will analyse the quantitative data. Grounded theory will guide the qualitative data analysis. Discussion: This study will determine whether planned Patient-Centred Family Meetings are feasible and acceptable and assess the suitability and feasibility of the outcome measures. It will inform a future phase III randomised controlled trial. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12616001083482 on 11 August 201

The transformative meanings of viewing or not viewing the body after sudden death

This study investigates the experience of viewing or not viewing the body for 64 relatives bereaved after a sudden and unexpected death1. Thematic analyses of in-depth interviews reveal the importance of viewing and the challenges in providing choice. Some participants experienced difficulties including regret and intrusive images. These are discussed alongside the transformative meanings of seeing or not seeing the body for bereaved relatives

\u27What’s on your mind?\u27 The only necessary question in spiritual care

Around the world, chaplains provide specialist spiritual care for people with complex healthcare needs. If the nature of chaplain interventions was better understood then multidisciplinary colleagues could both improve their own skills in spiritual care and better understand when to refer people to chaplains. A survey was constructed to establish what aspects of the chaplain/patient relationship were most important for patients in Scotland and Australia. Outcomes were measured with the Scottish Patient Reported Outcome Measure (Scottish PROM©). Results from 610 respondents showed the strongest correlation was between ‘being able to talk about what is on my mind’ and the Scottish PROM (rs(452) = .451, p \u3c .0005). ‘Being able to talk about what is on my mind’ proved more important than being listened to, having faith/beliefs valued, or being understood. Given the importance placed on listening and understanding by clinicians, this original and counterintuitive finding goes some way to explaining the unique role and function of healthcare chaplaincy

How do patients With advanced cancer cope with an uncertain disease trajectory? Implications for grief counselling

A growing number of cancer patients are living longer with incurable disease. This paper describes strategies that patients use to cope with the uncertain trajectory of their disease. Twenty-seven patients with a prognosis of 12 months were recruited from the oncology and palliative care service at three metropolitan Sydney hospitals. A semi-structured face-to-face interview was conducted, which was audiotaped and transcribed verbatim. The patients coped with the uncertain trajectory of their disease through avoidance, maintaining a normal life, comparing themselves favourably with others in a similar situation and remaining positive. Participants indicated that they did not wish referral for psychological support. The implications of these findings and the influence of grief counselling are explored