UKD
Universitätsklinikum Düsseldorf
What is the published evidence on values of undergraduate medical students on the topic of palliative care education? Scherg A., Wenzel-Meyburg U., Junius L., Schmitz A., Jansen J., Schulz C.
Search Filter PubMed
Background
Including criteria: published between 2000 and Jan 22.,2014 Excluding criteria: title or abstract not available in German or English
Our goal was to explore the existing evidence from the user perspective on what
Theme
Search Filter
Reference
Results
Palliative Care
advance care planning OR attitude to death OR bereavement OR death OR hospices OR life support care OR palliative care OR terminal care OR terminally ill OR palliat* OR hospice* OR terminal care OR terminally ill patient OR terminal care OR palliat* OR hospice* OR end of life care OR EOL care OR palliative therapy OR palliative therapy
Sladek et al (2006) Dietz et al (2013)
451837
Methods
2
Values
Attitude* OR perceptions OR Qualitative OR Coping OR Counseling OR Cultural OR Ethics OR Experiences OR interviews OR Perceived OR Personal OR Professionals OR QOL OR Quality of Life OR Relations OR Respondents OR Satisfaction OR Staff OR Well-being OR Adaptation, Psychological OR Nurse Role OR Social Support
Petrova et al (2011)
3952447
Systematic Literature Review (Medline, Google Scholar) considering the following search filter (Figure 1: Search Filter)
3
Education
Curriculum OR lecture OR teach* OR learn* OR program* OR educat* OR class
Chan (2013)
4
Medical Student
used as MeSH Term
1
Total
1246839 12236
(((medical students[MeSH Terms]) AND ((Curriculum OR lecture OR teach* OR learn* OR program* OR educat* OR class))) AND ((advance care planning OR attitude to death OR bereavement OR death OR hospices OR life support care OR palliative care OR terminal care OR terminally ill OR palliat* OR hospice* OR terminal care OR terminally ill patient OR terminal care OR palliat* OR hospice* OR end of life care OR EOL care OR palliative therapy OR palliative therapy ))) AND ((Attitude* OR perceptions OR Qualitative OR Coping OR Counseling OR Cultural OR Ethics OR Experiences OR interviews OR Perceived OR Personal OR Professionals OR QOL OR Quality of Life OR Relations OR Respondents OR Satisfaction OR Staff OR Well-being OR Adaptation, Psychological OR Nurse Role OR Social Support))
Figure 1: Search Filter
425
Complemented with hand searching of the German Journal “Zeitschrift für Palliativmedizin”
constitutes successful and meaningful learning within the context of UPCE.
Qualitative analysis (34 articles) was based on PRISMA State and following recommendations after Thomas and Mayring. (Figure 2: Steps of Qualitative Data Analysis)
1
line-by-line coding
2
development of descriptive themes
3
generation of analytical themes
paraphrasing generalization reduction Development and Discussion of a Mind Map (FreeMind)
Figure 2: Steps of Qualitative Data Analysis
Results 425 articles exclusion of title (191) or missing translation (6)
234 abstracts screened
94 full texts screened
8 articles hand search
exclusion of abstract (126) or missing availability (14)
exclusion of full text (22)
Inclusion: 80 articles
study type
number
quantitative design, including
46
interventional study
19
observational study
26
review
1
qualitative design, including
34
case report
3
essay
4
letter
1
Figure 3: Flowchart Systematic Literature Review + Table 1: Included Studies
attitude towards caring for the dying
aspects of medical education
euthanasia
positive attitude
poor level of preparedness
“I don‘t think anything can prepare a young student to deal with this positive (dying) situation. There is attitude no feasible way to train someone how to deal with the death of their patient.” insecurity lack of knowledge
aspects of death and dying. In terms of teaching interventions, medical students prefer real patient contact and reflection of their own experiences and emotions concerning death. They are eager to learn from experienced clinical role models. This review highlights important deficits in undergraduate palliative care education and provides user-centred suggestions for improvement.
expectations prior to UPCE
depressing setting “I mean we could sit through hours and hours of lecture, but 5 minutes with a patient, we learn more.”
methodical aspects in UPCE
approval of euthanasia is declining during medical training
clinical orientation
understanding of death “I thought I would find out what death actually is”
Death Education
role models
guilt
1. Moher, D., et al., Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg, 2010. 8(5): p. 336-41. 2. Mayring, P., Qualitative Inhaltsanalyse: Grundlagen und Techniken. 2010: Beltz. 3. Thomas, J. and A. Harden, Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol, 2008. 8: p. 45.
emotional involvement Figure 5: Qualitative Results
izp
truth telling in a cultural context
Figure 4: Quantitative Results
References
Interdisziplinäres Zentrum für Palliativmedizin
truth telling in a cultural context
qualitative studies…
Discussion This Systematic Literature Review confirms prior evidence on students’ low self-estimation of competence and preparedness in caring for dying patients. What is new is a clear overall finding which supports an understanding of UPCE that exceeds communication and symptom control training. Med ical students who are learners in Palliative Care want to receive Death Education, that is, explicit training in existential, philosophical and spiritual
quantitative studies…
www.uniklinik-duesseldorf.de/palliativmedizin/
[email protected]
“I’m also scared about feeling helpless when the point comes that there isn’t anything else to do except be supportive and treat symptoms. “
amazement
happiness fear
sadness
