The required competencies of physicians within palliative care from the perspectives of multi-professional expert groups : a qualitative study

Background Although statements on the competencies required from physicians working within palliative care exist, these requirements have not been described within different levels of palliative care provision by multi-professional workshops, comprising representatives from working life. Therefore, the aim of this study was to describe the competencies required from physicians working within palliative care from the perspectives of multi-professional groups of representatives from working life. Methods A qualitative approach, using a workshop method, was conducted, wherein the participating professionals and representatives of patient organizations discussed the competencies that are required in palliative care, before reaching and documenting a consensus. The data (n = 222) was collected at workshops held in different parts of Finland and it was analyzed using a qualitative content analysis method. Results The description of the competencies required of every physician working within palliative care at the general level included 13 main categories and 50 subcategories in total. 'Competence in advanced care planning and decision-making' was the main category which was obtained from the highest number of reduced expressions from the original data (f = 125). Competence in social interactions was another strong main category (f = 107). In specialist level data, six main categories with 22 subcategories in total were found. 'Competence in complex symptom management' was the main category which was obtained from the biggest number of reduced expressions (f = 46). A notable association between general level and specialist level data was related to networking, since one of the general level categories was 'Competence in consultations and networking' (f = 34) and one of the specialist level categories was 'Competence to offer consultative and educational support to other professionals' (f = 30). Moreover, part of the specialist level results were subcategories which belonged to the main categories produced from the general level data. Conclusions The competencies described in this study emphasize decision-making, social interactions and networking. It is important to listen to the voices of the working-life representatives when planning curricula. Moreover, the views of the working-life representatives inform how the competencies gained during their education meet the challenges of the ordinary work.Peer reviewe

The Trail, 1961-05-02

https://soundideas.pugetsound.edu/thetrail_all/1827/thumbnail.jp

Undergraduate curriculum in palliative medicine at Tampere University increases students' knowledge

Background: Education in palliative medicine (PM) at medical schools reveals wide variation despite the increasing importance of palliative care. Many universities present poor description of the benefits and detailed content of the total curriculum in PM. Using the recommendations of European Association for Palliative Care (EAPC) as a reference, we evaluated the content and outcomes of the curriculum in PM at the University of Tampere, Finland. Methods: We searched for a PM curriculum by examining the teaching offered by every specialty and compared it to EAPC recommendations. Students' knowledge was evaluated using a progress test over three consecutive years. Results: We found 53.5 teaching hours addressing PM issues, which exceeds the recommendation of the EAPC. Basics, symptom management, ethics, and communication skills were well established, while education in psychosocial/spiritual aspects, teamwork and self-reflection failed to reach the recommendations. Out of the maximum of 4.0, the progress test mean scores in PM among the third, fourth, fifth and sixth year students were 0.1 (SD 0.71), 0.69 (SD 1.28), 1.38 (SD 1.46) and 2.53 (SD 1.26), respectively (p <0.001). This growing knowledge was associated with the timely increase in teaching provided through the PM discipline. In addition, the students who completed the optional PM course achieved better mean scores (2.66; SD 1.27) than the others (1.33; SD 1.43) (p <0.001). Conclusions: The curriculum in PM at the University of Tampere is integrated into the teaching of many disciplines and complied well with the EAPC recommendations. This education led to increasing knowledge in PM among medical students.Peer reviewe

mMRC dyspnoea scale indicates impaired quality of life and increased pain in patients with idiopathic pulmonary fibrosis

Peer reviewe

Cancer Patients' Symptom Burden and Health-related Quality of Life (HRQoL) at Tertiary Cancer Center from 2006 to 2013 : A Cross-sectional Study

Background/Aim: To observe changes in symptoms and health-related quality of life (HRQoL) over 7 years among cancer patients at different stages of the disease. Patients and Methods: This prospective cross-sectional study at the Helsinki University Hospital Cancer Center, was carried out in 2006 and repeated in 2013. All participants filled in the EORTC-QLQ-C30 questionnaire. Results: Altogether, 581 patients responded (49% in 2006 and 54% in 2013). The disease was local in 51% and advanced in 49% of patients. The HRQoL was significantly lower, except for emotional and cognitive functions, and the symptom burden more severe in advanced cancer. The most prevalent symptoms were fatigue (93% and 85%; moderate/severe 22% and 9%), pain (65% and 47%; moderate/severe 16% and 5%), and insomnia (64% and 60%; moderate/severe 20 and 21%), respectively. No changes in HRQoL or symptoms were found at 7 years. Conclusion: There is a need for early integrated palliative care to improve HRQoL during cancer treatments.Peer reviewe

Asiantuntijoiden näkemyksiä palliatiivisen hoidon ja saattohoidon kehittämis- ja tutkimustarpeista

Vertaisarvioitu. English summary.Peer reviewe

Palliative care patients in the emergency medical service : a retrospective cohort study from Finland

BACKGROUND: Paramedics are often involved in treating palliative care patients with difficulties regarding symptom control. They report minimal training in palliative care and find decision-making difficult. This often leads to overtreatment and unnecessary transportation to the emergency department. The study's objective is to determine how much palliative patients use emergency services, how well are they recognized by paramedics and how paramedics choose care in terms of treatment and transportation. METHODS: This study is a retrospective cohort study based in the Finnish Tampere University Hospital area. We included patients with a palliative care decision setting the goal of therapy as palliative intent between 1 August 2021 and 31 December 2021 and who died before 1 April 2022. From these patients, records of nurse paramedic visits were retrieved. Descriptive statistics were used to describe the data. RESULTS: Paramedics visited 69 patients in 97 callouts. These callouts comprised 0.26% of the total dispatches in the study area. The most common reasons for callouts were general weakness, breathing difficulty and pain. The paramedics provided treatment in 40% of the missions. 55% of the patients were transported to the emergency department. A palliative care plan was recognized by the paramedics in 42 of the 97 callouts. A total of 38 patients were recognized as palliative care patients by the paramedics while in the cases of 31 patients, palliative care was not recognized in any dispatch. CONCLUSION: Patients in palliative care cause only a minimal load on the emergency medical services, but the paramedics do not necessarily recognize them as such. This leads to the risk of overtreatment and a high transportation rate to the emergency department, which is not an ethical choice. Recognition and treatment provided to palliative care patients by the paramedics could be improved with additional training and greater availability of patient records.Peer reviewe

End-of-life care of patients with idiopathic pulmonary fibrosis

Background: Idiopathic pulmonary fibrosis (IPF) is a progressive disease with median survival from 2 to 7 years. Palliative care is an important part of patients' care as lung transplantation is not an option for the majority of patients. The aim of this study was to describe treatment practices, decision-making and symptoms during end-of-life care of IPF patients. Methods: We identified 59 deceased patients from a national prospective IPF cohort study (FinnishIPF) and analyzed retrospectively their health care documentation during the 6 months that preceded death. Results: Hospital was the place of death for 47 patients (80 %). A majority of the patients (93 %) were hospitalized for a mean of 30 days (range 1-96 days) during the last 6 months of their life. Altogether, patients spent 15 % of their last 6 months of life in a hospital. End-of-life decisions and do not resuscitate (DNR) orders were made for 19 (32 %) and 34 (57 %) of the patients, respectively, and 22 (42 %) of these decisions were made Conclusions: The majority of IPF patients died in a hospital with ongoing life-prolonging procedures until death. The frequent use of opioids is an indicator of an intention to relieve symptoms, but end-of-life decisions were still made very late. Early integrated palliative care with advance care plan could improve the end-of-life care of dying IPF patients.Peer reviewe

Palliatiivisen lääketieteen opetus lääketieteen kandidaattien arvioimana

Vertaisarvioitu. English summary.Lähtökohdat : Palliatiivinen lääketiede on lääkärin ydinosaamista, mutta alan professuuri ja opetussuunnitelma ovat vain Helsingin ja Tampereen yliopistoissa. Menetelmät : Lukuvuonna 2018–2019 kaikissa Suomen lääketieteellisissä tiedekunnissa kysyttiin kysely¬lomakkeella valmistuvien kandidaattien näkemyksiä palliatiivisen lääketieteen opetuksesta. Tulokset : Vastaajista (n = 502) lähes kaikki (98 %) pitivät palliatiivisen lääketieteen opetusta hyödyllisenä. Opetus oli kattanut parhaiten kivun hoidon, heikoimmin psyykkiset oireet ja psykososiaalisen tuen. Lisäopetusta olisi kaivattu eniten hoitolinjauksista ja psykososiaalisista seikoista. Tampereen ja Helsingin yliopistojen vastaajat kokivat opetuksen kattaneen paremmin lähes kaikki osa-alueet verrattuna muiden yliopistojen vastaajiin. Helsingin ja Tampereen opiskelijoista 80–90 % kertoi kohdanneensa saattohoitopotilaan opetuksessa, kun muista näin arvioi noin kolmannes. Avoimissa vastauksissa korostui tarve opetukseen ennen ensimmäisiä lääkärin työtehtäviä. Päätelmät : Kokemukset palliatiivisen lääketieteen opetuksesta vaihtelivat yliopistojen välillä. Valtakunnallisen palliatiivisen lääketieteen opetussuunnitelman käyttöönotto on tarpeen.Peer reviewe

Palliatiivisen lääketieteen opetus lääketieteen kandidaattien arvioimana

Lähtökohdat Palliatiivinen lääketiede on lääkärin ydinosaamista, mutta alan professuuri ja opetussuunnitelma ovat vain Helsingin ja Tampereen yliopistoissa. Menetelmät Lukuvuonna 2018–2019 kaikissa Suomen lääketieteellisissä tiedekunnissa kysyttiin kysely­lomakkeella valmistuvien kandidaattien näkemyksiä palliatiivisen lääketieteen opetuksesta. Tulokset Vastaajista (n = 502) lähes kaikki (98 %) pitivät palliatiivisen lääketieteen opetusta hyödyllisenä. Opetus oli kattanut parhaiten kivun hoidon, heikoimmin psyykkiset oireet ja psykososiaalisen tuen. Lisäopetusta olisi kaivattu eniten hoitolinjauksista ja psykososiaalisista seikoista. Tampereen ja Helsingin yliopistojen vastaajat kokivat opetuksen kattaneen paremmin lähes kaikki osa-alueet verrattuna muiden yliopistojen vastaajiin. Helsingin ja Tampereen opiskelijoista 80–90 % kertoi kohdanneensa saattohoitopotilaan opetuksessa, kun muista näin arvioi noin kolmannes. Avoimissa vastauksissa korostui tarve opetukseen ennen ensimmäisiä lääkärin työtehtäviä. Päätelmät Kokemukset palliatiivisen lääketieteen opetuksesta vaihtelivat yliopistojen välillä. Valtakunnallisen palliatiivisen lääketieteen opetussuunnitelman käyttöönotto on tarpeen.</p