A survey of physicians' education in caring for the dying: identified training needs.

BACKGROUND: Physicians receive limited systematic training in caring for dying people. The majority of training focuses on technical skills. METHODS: This study surveyed medical students, residents, fellows, and attending physicians to identify physician needs and current types of training in caring for the terminally ill. The study questionnaire was designed to determine whether and when physicians were trained in caring for dying people, the nature of such training, and possible areas to be included in future training. Also requested was a description of a personal experience involving caring for a terminally ill person. RESULTS: One hundred twenty-three questionnaires were distributed and 90 were returned. Data indicate a lack of standardized training in dealing with terminally ill people and an expressed need for periodic, continuous training. The training needs to be mandatory, be ongoing, and use multiple formats, including the integration of theoretical information and clinical practice. Physicians in this study desired training in the following topic areas: 1) pain management; 2) death and dying; 3) the quality of life and death; 4) DNR status. CONCLUSIONS: Physicians in this study indicated a need for more training in how to care for the terminally ill. A model for training should start in medical school and continue throughout one's career. Providing a framework for lifelong professional development that integrates theoretical information and clinical practice with a multidisciplinary approach to patient care should form the basis of a training model.

A randomized controlled prospective outcome study of a psychological and pharmacological intervention protocol for procedural distress in pediatric leukemia.

Evaluated distress during invasive procedures in childhood leukemia. Child and parent distress, assessed by questionnaires and ratings, were compared in two arms of a randomized, controlled prospective study, one a pharmacologic only (PO) (n = 45) and the other a combined pharmacologic and psychological intervention (Cl) (n = 47), at 1, 2, and 6 months after diagnosis. The cross-sectional control group (CC) consisted of parents of 70 patients in first remission prior to the prospective study. Mothers' and nurses' ratings of child distress indicated less child distress in the Cl group than the PO. When contrasted with the CC group, the Cl group showed lower levels of child distress. Data showed decreases over time in distress and concurrent improvements in quality of life and parenting stress and supported an inverse association between distress and child age.

The Perception of Procedures Questionnaire: psychometric properties of a brief parent report measure of procedural distress.

Reported the reliability and validity of the Perception of Procedures Questionnaire (PPQ), a 19-item parent-report measure developed to assess child and parent distress related to lumbar punctures and bone marrow aspirates in the diagnosis and treatment of childhood cancer. PPQ data from 140 mothers and 96 fathers of children and adolescents with leukemia in a first remission were analyzed separately. Factor analyses yielded five factors for mothers and fathers: Parent Satisfaction; Child Distress: During; Child Distress: Before; Parent Distress; and Parent Involvement. Internal consistency (Cronbach's alpha) was high for the total score and the five factor scores as were interrater reliabilities between mothers and fathers. Validity was determined using the Parenting Stress Index-Short Form, the Pediatric Oncology Quality of Life Scale, and parent and nurse ratings during procedures. Factors 2 and 3, assessing child distress, show strong associations with the validation measures and support the distinction between distress before and during procedures. This developing scale is recommended for use in the assessment and evaluation of child and parent procedure-related distress in pediatric oncology.