How Islam Influences End-of-Life Care: Education for Palliative Care Clinicians.

CONTEXT: According to the Joint Commission, cultural competency is a core skill required for end-of-life care. Religious and cultural beliefs predominantly influence patients' lives, especially during the dying process. Therefore, palliative care clinicians should have at least a basic understanding of major world religions. Islam is a major world religion with 1.7 billion followers. At our institution, a needs assessment showed a lack of knowledge with Islamic teachings regarding end-of-life care. OBJECTIVES: To improve knowledge of clinically relevant Islamic teachings regarding end-of-life care. METHODS: After consultation with a Muslim chaplain, we identified key topics and created a 10-question pretest. The pretest was administered, followed by a one-hour educational intervention with a Muslim chaplain. Next, a post-test (identical to the pretest) was administered. RESULTS: Eleven palliative care clinicians participated in this study. The average score on the pretest was 6.0 ± 1.2 (mean + SD) (maximum 10). After the educational intervention, the average score improved to 9.6 ± 0.7 (95% CI 2.7-4.4; P < 0.001). Qualitative feedback was positive as participants reported a better understanding of how Islam influences patients' end-of-life decisions. CONCLUSION: In this pilot study, a one-hour educational intervention improved knowledge of Islamic teachings regarding end-of-life care. We present a framework for this intervention, which can be easily replicated. We also provide key teaching points on Islam and end-of-life care. Additional research is necessary to determine the clinical effects of this intervention over time and in practice. In the future, we plan to expand the educational material to include other world religions.

Dizziness handicap after cartilage cap occlusion for superior semicircular canal dehiscence.

OBJECTIVE: To evaluate the change in self-reported dizziness handicap after surgical repair using the cartilage cap occlusion technique in cases of superior canal dehiscence (SCD). STUDY DESIGN: Repeated measures, retrospective chart review. SETTING: Tertiary referral center. PATIENTS: Twenty patients over a 2-year period who underwent surgical repair of SCD using the cartilage cap occlusion technique. INTERVENTION: Therapeutic. MAIN OUTCOME MEASURE: Preoperative and postoperative Dizziness Handicap Inventory (DHI) questionnaires were completed (median, interquartile range). RESULTS: Preoperative (48, 28-56) and postoperative (33, 19-50) total scores were not significantly different. Scores for patients with moderate/severe preoperative DHI scores (DHI, >30; n = 14) demonstrated significant change (p = 0.001, Wilcoxon paired sample test), whereas those with mild scores did not (DHI, ≤ 30; n = 6; p = 0.67). CONCLUSION: Change in DHI score is variable. As described by DHI score, patients with higher preoperative handicap may demonstrate significant improvement after surgery, whereas those with mild handicap may not. These results are similar to previous reports and indicate that the cartilage cap occlusion technique may provide an alternative to middle fossa craniotomy approach for surgical management of symptomatic SCD.