What are the communication skills and needs of doctors when communicating a poor prognosis to patients and their families? A qualitative study from South Africa

Background. Thousands of South Africans are diagnosed with life-threatening illness every year. Research shows that, globally, of the 20 million people who need palliative care at the end of life every year, <10% receive it.Objectives. To explore communication skills and practices of medical practitioners when conveying a poor prognosis to patients and families, and to identify their communication skills, needs and understanding of palliative care.Methods. This was an exploratory qualitative study of practising doctors, using a grounded theory approach. The study was conducted at a government-funded public hospital in Cape Town, South Africa, which is a referral centre for various illnesses, including cancer. Face-toface, one-on-one interviews using a semistructured interview guide were conducted, using audio recording.Results. The emerging theory from this study is that doctors who understand the principles of palliative care and who have an established working relationship with a palliative care team feel supported and express low levels of emotional anxiety when conveying a poor prognosis.Conclusion. Having hospital-based palliative care teams in all public hospitals will provide support for patients and doctors handling difficult conversations. All healthcare professionals should be trained in palliative care so that they can effectively communicate concerns related to poor prognosis with patients and their families. Communication, loss and grief issues should be part of the curriculum in all disciplines and throughout training in medical school

Evaluating palliative care training in the oncology registrar programme in South Africa

Background. Following a World Health Assembly call in 2014 to strengthen palliative care, the South African (SA) Department of Health approved this strategy as part of the SA National Policy Framework and Strategy on Palliative Care. In 2016, the University of Cape Town, together with the College of Radiation Oncology of SA, identified the need to integrate palliative care (PC) into the oncology curriculum. In collaboration with the Cancer Association of SA, a research project was developed to introduce a 12-module curriculum at five teaching hospitals. The aim of this research was to evaluate the impact of a 1-year PC course within the training programme for specialist oncologists in SA. Objective. To determine the reaction of oncology registrars and their supervisors to the course to determine changes in knowledge and skills, and to determine the application in oncology practice. Methods. This study was a mixed-method prospective evaluation of an educational intervention. The educational programme used a blended learning method to train and support registrars (n=32) and facilitators (n=5) across five universities from August 2017 to September 2018. Evaluation feedback was electronically collected to determine the registrars’ reactions to the course materials. Pre and post multiple-choice questions (MCQs) were used to review their knowledge. Focus group discussions (FGDs) were used to explore reactions, change in knowledge and skills and how registrars integrated PC into their daily work. Results. There was an overwhelmingly positive reaction to the PC course by the oncology registrars and their supervisors. The training was found to be feasible, and the topics addressed appropriate. Concerns previously raised by the College of Radiation Oncology of SA regarding the feasibility and appropriateness of the course and material were found to be unsubstantiated. The poor MCQ results can be ascribed to poor sequencing of the execution of the question. However, the MCQs in modules 7 and 8 (symptom management) demonstrated the most significant change in knowledge and skills (symptom management). The FGDs demonstrated a perceived change in knowledge and skills, especially for communication skills and pain and symptom management. The FGDs also indicated that the registrars’ approach to PC changed in that they were able to integrate the principles of PC into practice, and now saw PC as an essential component of oncology. Lastly, registrars and their supervisors felt that the course addressed topics that formed part of their daily clinical work. Conclusion. This research supports the view that PC training is an essential component of oncology training in the SA setting. PC forms part of the daily practice of oncologists, and a structured curriculum prepares clinicians to be able to integrate evidence-based PC into the practice of oncology if they receive appropriate training. Supervisors of the oncology training programme and registrars are confident that the training of 12 modules across 1 year is feasible and appropriate

What are the communication skills and needs of doctors when communicating a poor prognosis to patients and their families? A qualitative study from South Africa

Background. Thousands of South Africans are diagnosed with life-threatening illness every year. Research shows that, globally, of the 20 million people who need palliative care at the end of life every year, <10% receive it.Objectives. To explore communication skills and practices of medical practitioners when conveying a poor prognosis to patients and families, and to identify their communication skills, needs and understanding of palliative care.Methods. This was an exploratory qualitative study of practising doctors, using a grounded theory approach. The study was conducted at a government-funded public hospital in Cape Town, South Africa, which is a referral centre for various illnesses including cancer. Face-to-face, one-on-one interviews using a semistructured interview guide were conducted, using audio recording.Results. The emerging theory from this study is that doctors who understand the principles of palliative care and who have an established working relationship with a palliative care team feel supported and express low levels of emotional anxiety when conveying a poor prognosis.Conclusion. Having hospital-based palliative care teams in all public hospitals will provide support for patients and doctors handling difficult conversations. All healthcare professionals should be trained in palliative care so as to effectively communicate with patients and their families concerns related to poor prognosis. Communication, loss and grief issues should be part of the curriculum in all disciplines and throughout training in medical school

Impact of ocean forcing on the Aurora Basin in the 21st and 22nd centuries

The grounded ice in the Totten and Dalton glaciers is an essential component of the buttressing for the marine-based Aurora basin, and hence their stability is important to the future rate of mass loss from East Antarctica. Totten and Vanderford glaciers are joined by a deep east-west running subglacial trench between the continental ice sheet and Law Dome, while a shallower trench links the Totten and Dalton glaciers. All three glaciers flow into the ocean close to the Antarctic circle and experience ocean-driven ice shelf melt rates comparable with the Amundsen Sea Embayment. We investigate this combination of trenches and ice shelves with the BISICLES adaptive mesh ice-sheet model and ocean-forcing melt rates derived from two global climate models. We find that ice shelf ablation at a rate comparable with the present day is sufficient to cause widespread grounding line retreat in an east-west direction across Totten and Dalton glaciers, with projected future warming causing faster retreat. Meanwhile, southward retreat is limited by the shallower ocean facing slopes between the coast and the bulk of the Aurora sub-glacial trench. However the two climate models produce completely different future ice shelf basal melt rates in this region: HadCM3 drives increasing sub-ice shelf melting to ~2150, while ECHAM5 shows little or no increase in sub-ice shelf melting under the two greenhouse gas forcing scenarios

Modelling the Response of Ice Shelf Basal Melting to Different Ocean Cavity Environmental Regimes

We present simulation results from a version of the Regional Ocean Modeling System modified for ice shelf/ocean interaction, including the parameterisation of basal melting by molecular diffusion alone. Simulations investigate the differences in melting for an idealised ice shelf experiencing a range of cold to hot ocean cavity conditions. Both the pattern of melt and the location of maximum melt shift due to changes in the buoyancy-driven circulation, in a different way to previous studies. Tidal forcing increases both the circulation strength and melting, with the strongest impact on the cold cavity case. Our results highlight the importance of including a complete melt parameterisation and tidal forcing. In response to the 2.4 degrees C ocean warming initially applied to a cold cavity ice shelf, we find that melting will increase by about an order of magnitude (24 x with tides and 41 x without tides)

Borehole tensor strain measurements in California ( USA)

Two continuous borehole plane strain monitoring sites have been operational in California since late 1983, using borehole tensor strain monitors implanted at a depth of 150 m. Shear strain data at subtidal sensitivies were available immediately after installation without contamination by bond curing or thermal recovery signals. At Pinon Flat Observatory, data indicate a constant shear strain accumulation of 0.6 microstrain per annum with the axis of maximum compression oriented 50o + or - 5o W of N. This result differs significantly from regional geodetic estimates, the amplitude being dominated by continued visoelastic response of the hole. Preliminary analysis of strain steps observed at San Juan Bautista during the Morgan Hill earthquake of April 24, 1984 show good agreement with calculations from seismically determined source parameters for this event. -from Author

Ocean forced variability of Totten Glacier mass loss

This is the author accepted manuscript. The final version is available from the Geological Society of London via the DOI in this record.A large volume of the East Antarctic Ice Sheet drains through the Totten Glacier (TG) and is thought to be a potential source of substantial global sea level rise over the coming centuries. We show the surface velocity and heightof the floating part of TG, which buttresses the grounded component, have varied substantially over two decades (1989–2011), with variations in surface height strongly anti-correlated with simulated basal melt rates (r=0.70, p<0.05). Coupled glacier/ice-shelf simulations confirm ice flow and thickness respond to both basal melting of the ice shelf and grounding on bed obstacles. We conclude the observed variability of TG is primarily ocean-driven. Ocean warming in this region will lead to enhanced ice-sheet dynamism and loss of upstream grounded ice.This work was supported by, Australian Antarctic Division projects 3103, 4077, 4287 and 4346, National Computing Infrastructure grant m68, NSF grant ANT-0733025, NASA grant NNX09AR52G (Operation Ice Bridge), NERC grant NE/F016646/1, NERC fellowship NE/G012733/2, the Jackson School of Geoscience, the Jet Propulsion Laboratory and the G. Unger Vetlesen Foundation. This research was also supported by the Australian Government’s Cooperative Research Centres Programme through the Antarctic Climate & Ecosystems Cooperative Research Centre. The work is also supported under the Australian Research Councils Special Research Initiative for Antarctic Gateway Partnership SR140300001. Landsat 4 and 7 images courtesy of the U.S. Geological Survey. This is UTIG contribution 2486. Thanks to Benoit Legresy for useful discussions