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1.
J Allergy Clin Immunol ; 148(5): 1176-1191, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34508765

RESUMO

BACKGROUND: The risk of severe coronavirus disease 2019 (COVID-19) varies significantly among persons of similar age and is higher in males. Age-independent, sex-biased differences in susceptibility to severe COVID-19 may be ascribable to deficits in a sexually dimorphic protective attribute that we termed immunologic resilience (IR). OBJECTIVE: We sought to examine whether deficits in IR that antedate or are induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection independently predict COVID-19 mortality. METHODS: IR levels were quantified with 2 novel metrics: immune health grades (IHG-I [best] to IHG-IV) to gauge CD8+ and CD4+ T-cell count equilibrium, and blood gene expression signatures. IR metrics were examined in a prospective COVID-19 cohort (n = 522); primary outcome was 30-day mortality. Associations of IR metrics with outcomes in non-COVID-19 cohorts (n = 13,461) provided the framework for linking pre-COVID-19 IR status to IR during COVID-19, as well as to COVID-19 outcomes. RESULTS: IHG-I, tracking high-grade equilibrium between CD8+ and CD4+ T-cell counts, was the most common grade (73%) among healthy adults, particularly in females. SARS-CoV-2 infection was associated with underrepresentation of IHG-I (21%) versus overrepresentation (77%) of IHG-II or IHG-IV, especially in males versus females (P < .01). Presentation with IHG-I was associated with 88% lower mortality, after controlling for age and sex; reduced risk of hospitalization and respiratory failure; lower plasma IL-6 levels; rapid clearance of nasopharyngeal SARS-CoV-2 burden; and gene expression signatures correlating with survival that signify immunocompetence and controlled inflammation. In non-COVID-19 cohorts, IR-preserving metrics were associated with resistance to progressive influenza or HIV infection, as well as lower 9-year mortality in the Framingham Heart Study, especially in females. CONCLUSIONS: Preservation of immunocompetence with controlled inflammation during antigenic challenges is a hallmark of IR and associates with longevity and AIDS resistance. Independent of age, a male-biased proclivity to degrade IR before and/or during SARS-CoV-2 infection predisposes to severe COVID-19.


Assuntos
COVID-19/imunologia , Infecções por HIV/epidemiologia , HIV-1/fisiologia , Insuficiência Respiratória/epidemiologia , SARS-CoV-2/fisiologia , Fatores Sexuais , Linfócitos T/imunologia , Adulto , Idoso , COVID-19/epidemiologia , COVID-19/mortalidade , Estudos de Coortes , Resistência à Doença , Feminino , Humanos , Imunocompetência , Interleucina-6/sangue , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Índice de Gravidade de Doença , Análise de Sobrevida , Transcriptoma/imunologia , Estados Unidos/epidemiologia , Carga Viral
2.
J Pain Symptom Manage ; 61(3): 613-627, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33091584

RESUMO

Education leaders in hospice and palliative medicine (HPM) have long acknowledged the challenge of fellow performance assessment and the need for HPM-specific fellow assessment tools. In 2010, and in alignment with the Accreditation Council for Graduate Medical Education's (ACGME's) directive toward competency-based medical education, the national HPM Competencies Workgroup curated a set of assessment tools, the HPM Toolkit of Assessment Methods. The Toolkit has been a resource for HPM fellowship directors in evolving practical, multifaceted fellow assessment strategies. Now, as American Academy of Hospice and Palliative Medicine plans for a national workgroup in 2020 to define current HPM fellow assessment methods and to propose strategies to strengthen and standardize future assessment, the Toolkit provides a strong base from which to launch. However, the field learned important lessons from the 2010 Workgroup about the consensus process, gaps in areas of assessment, opportunities to address gaps with new or adapted tools, and limitations in implementing the Toolkit over time in terms of tracking, accessibility, and dissemination. This article describes the development of the Toolkit, including recommended tools and methods for assessment within each ACGME competency domain, and links the lessons learned to recommendations for the 2020 workgroup to consider in creating the next HPM assessment strategy and toolkit. Effective implementation will be crucial in supporting fellows to reach independent practice, which will further strengthen the field and workforce to provide the highest quality patient and family-centered care in serious illness. This will require an inspired, committed effort from the HPM community, which we enthusiastically anticipate.


Assuntos
Cuidados Paliativos na Terminalidade da Vida , Hospitais para Doentes Terminais , Medicina Paliativa , Educação de Pós-Graduação em Medicina , Bolsas de Estudo , Humanos , Medicina Paliativa/educação , Estados Unidos
3.
J Palliat Med ; 23(6): 871-873, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31509060

RESUMO

Hypercalcemia of malignancy affects 2%-2.8% of cancer patients and is associated with an increased risk of mortality and other symptom-related complications. Standard treatment consists of fluid resuscitation, intravenous bisphosphonates, and calcitonin. Little is known, however, about the benefits of treatment of malignant hypercalcemia in patients with late-stage terminal cancer. We present a case of a hospice patient with squamous cell lung cancer brought to our hospital with newly altered mental status who was found to have hypercalcemia of malignancy. Our discussion centers on the diagnostic dilemma of deciding which patients seeking comfort-focused care may benefit from fluid resuscitation for symptoms of hypercalcemia of malignancy while maintaining the unambiguous goal of comfort care.


Assuntos
Carcinoma de Células Escamosas , Hipercalcemia , Neoplasias , Síndromes Paraneoplásicas , Calcitonina , Difosfonatos , Humanos , Hipercalcemia/etiologia , Hipercalcemia/terapia , Cuidados Paliativos
4.
Gerontol Geriatr Educ ; 41(4): 508-513, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-29683782

RESUMO

Current standard geriatric curricula and exposure of students to the elderly may be insufficient to influence students' interest in geriatric medicine. We developed an innovative curriculum to address this gap. This study aimed to identify knowledge, skill, and attitude changes of first-year students in an accelerated baccalaureate-MD program toward geriatrics after participation in an early-exposure geriatrics curriculum (GC). The GC consisted of fifteen 3-hr interactive teaching sessions facilitated by various health professionals. This was a single group, pre- and post-intervention study using a knowledge test and attitude survey. To assess the effectiveness of this curriculum, students also completed an Objective Structured Clinical Exam (OSCE) on falls, cognitive and functional assessment, and delivering bad news. Twenty-seven baccalaureate-MD students (mean age = 18.8 years) participated in the GC intervention between January and April 2015. The post-GC showed significant improvement in knowledge (P = 0.013), skills, and attitude (P < 0.01) toward older adults. Students as a group overall met the standard of 85% of possible points in all three OSCE cases. This study shows that an early-exposure geriatric education intervention is associated with an increase in students' knowledge, skills, and attitudes in caring for older adults.


Assuntos
Currículo , Geriatria/educação , Conhecimentos, Atitudes e Prática em Saúde , Estudantes de Medicina/psicologia , Adolescente , Idoso , Competência Clínica , Educação de Graduação em Medicina , Feminino , Humanos , Masculino , Inquéritos e Questionários
5.
J Am Geriatr Soc ; 66(8): 1469-1474, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30277566

RESUMO

Older adults with cognitive impairment face many healthcare challenges, chief among them participating in medical decision-making about their own health care. Advance care planning (ACP) is the process whereby individuals communicate their wishes for future care with their clinicians and surrogate decision-makers while they are still able to do so. ACP has been shown to improve important outcomes for individuals with cognitive impairment, but rates of ACP for these individuals are low because of individual-, clinician-, and system-related factors. Addressing ACP early in the illness trajectory can maximize the chances that people can participate meaningfully. This article recommends best practices for approaching ACP for older adults with cognitive impairment. The importance of providing anticipatory guidance and eliciting values to guide future care to create a shared framework between clinicians, individuals, and surrogate decision-makers is emphasized. It is recommended that ACP be approached as an iterative process to continue to honor and support people's wishes as cognitive impairment progresses and increasingly threatens independence and function. The article describes effective strategies for assessing decision-making capacity, identifying surrogate decision-makers, and using structured communication tools for ACP. It also provides guidelines for documentation and billing. Finally, special considerations for individuals with advanced dementia are described, including the use of artificial hydration and nutrition, decisions about site of care, and the role of hospice care.


Assuntos
Planejamento Antecipado de Cuidados/normas , Disfunção Cognitiva/psicologia , Demência/psicologia , Guias de Prática Clínica como Assunto , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisão Clínica , Feminino , Humanos , Masculino
6.
Am J Hosp Palliat Care ; 35(3): 404-410, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28592164

RESUMO

OBJECTIVE: US Latinos historically have underutilized end-of-life (EOL) resources. This study reports the views of family caregivers before and after education intervention Caregivers Like Me geared to improve knowledge and attitudes regarding EOL resources among Latino caregivers. METHODS: This is a qualitative substudy within a multicentered cross-sectional study design. Educational intervention was offered to family caregivers of Latino elders from 3 different communities, using an audiovisual presentation, including a case-based video telenovela and pre-posttest questionnaires with open-ended questions. This study pertains to the qualitative results for the open-ended questions before and after education intervention. RESULTS: Participants (N = 145) were mostly females (79%) with a mean age of 56 ± 15 years and reported (92%) active learning from intervention. The pretest open-ended question on expected learning identified 2 themes, care for the sick and self-care. It included 5 subthemes and the most common one was how to help the sick. The posttest question on actual learning identified the same 2 themes and 4 subthemes that were similar but different from the pretest. Accepting help and knowledge of services available were the most common. CONCLUSION: The education intervention Caregivers Like Me was able to improve attitudes toward EOL care because participants who wanted to help their loved ones realized that they need to accept professional help and were made aware of the services available.


Assuntos
Cuidadores/educação , Conhecimentos, Atitudes e Prática em Saúde , Hispano-Americanos/psicologia , Assistência Terminal , Idoso , Atitude Frente a Morte , Conscientização , Estudos Transversais , Competência Cultural , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Estresse Psicológico/prevenção & controle , Estados Unidos
7.
J Pain Symptom Manage ; 55(1): 89-93, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28843457

RESUMO

CONTEXT: A cornerstone procedure in Palliative Medicine is to perform family meetings. Learning how to lead a family meeting is an important skill for physicians and others who care for patients with serious illnesses and their families. There is limited evidence on how to assess best practice behaviors during end-of-life family meetings. OBJECTIVES: Our aim was to develop and validate an observational tool to assess trainees' ability to lead a simulated end-of-life family meeting. METHODS: Building on evidence from published studies and accrediting agency guidelines, an expert panel at our institution developed the Family Meeting Assessment Tool. All fourth-year medical students (MS4) and eight geriatric and palliative medicine fellows (GPFs) were invited to participate in a Family Meeting Objective Structured Clinical Examination, where each trainee assumed the physician role leading a complex family meeting. Two evaluators observed and rated randomly chosen students' performances using the Family Meeting Assessment Tool during the examination. Inter-rater reliability was measured using percent agreement. Internal consistency was measured using Cronbach α. RESULTS: A total of 141 trainees (MS4 = 133 and GPF = 8) and 26 interdisciplinary evaluators participated in the study. Internal reliability (Cronbach α) of the tool was 0.85. Number of trainees rated by two evaluators was 210 (MS4 = 202 and GPF = 8). Rater agreement was 84%. Composite scores, on average, were significantly higher for fellows than for medical students (P < 0.001). CONCLUSION: Expert-based content, high inter-rater reliability, good internal consistency, and ability to predict educational level provided initial evidence for construct validity for this novel assessment tool.


Assuntos
Competência Clínica , Relações Profissional-Família , Assistência Terminal , Educação Médica , Comunicação em Saúde , Humanos , Cuidados Paliativos , Médicos , Reprodutibilidade dos Testes , Estudantes de Medicina
8.
Am J Hosp Palliat Care ; 34(7): 637-644, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27384610

RESUMO

BACKGROUND: The need for end-of-life (EOL), high-impact education initiatives to prepare medical students to communicate with dying patients and their families and to cope with issues of death and dying, is well recognized. METHODS: Third-year medical students (n = 224), during their ambulatory rotation, completed a multimedia EOL curriculum, which included pre-/posttests, an online case-based module, didactic presentation, and a tablet computer application designed to demonstrate the signs and symptoms seen in the last hours of life for families of dying patients. Pre- and posttests were compared using Pearson χ2 or Fisher exact test, and improvement was measured by weighted κ coefficient. RESULTS: On preintervention surveys, the majority of students demonstrated positive attitudes toward the care of dying patients and their families. Despite this high pretest positive attitude, there was a statistically significant overall positive attitude change after the intervention. The lowest pretest positive attitudes and lowest posttest positive attitude shifts, although all statistically improved, involved addressing the thoughts and feelings of dying patients and in coping with their own emotional response. CONCLUSIONS: Medical students exposure to this multimedia EOL curriculum increases positive attitudes in caring for dying patients and their families.


Assuntos
Educação Médica/métodos , Assistência Terminal , Adulto , Comunicação , Currículo , Família , Feminino , Humanos , Masculino , Multimídia , Relações Médico-Paciente , Ensino , Assistência Terminal/psicologia , Adulto Jovem
9.
Am J Hosp Palliat Care ; 34(10): 907-911, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27650219

RESUMO

BACKGROUND: Few educational interventions have been developed to teach Family Meeting (FM) communication skills at the undergraduate level. We developed an innovative curriculum to address this gap. METHODS: Fourth year medical students during 2011-2013 (n = 674) completed training for conducting a FM. To assess the effectiveness of this training, students completed a FM Objective Structured Clinical Exam (OSCE) that included 15 domains rated on a 1-5 point Likert scale. Tasks included discussing prognosis, establishing goals of care and demonstrating conflict resolution skills. Students received one-to-one feedback from standardized family members and faculty observers. Group debriefings with faculty were held after the OSCE. RESULTS: Analysis of faculty feedback narratives revealed four themes in which students required improvement: 1) Discussing prognosis, 2) Explaining palliative care/hospice, 3) Avoiding medical jargon, and 4) Discussing cultural/religious preferences. Evaluation total mean score was 28.2 (Min 15, Max 63; SD 7.57), and identified student's need to; 1) Ask more about the degree of knowledge family members want, 2) Ask religious beliefs, and 3) Assess family members' level of education ( p < 0.001). Qualitative analysis of group debriefings suggested that student perception of the OSCE experience was positive overall. Students found the case to be realistic and immediate feedback to be helpful. CONCLUSIONS: Conducting a FM is an advanced skill. This study shows that it is possible to train fourth year students to lead FMs and identify their strengths, needs using a FM OSCE.


Assuntos
Comunicação , Currículo , Educação de Graduação em Medicina/organização & administração , Família , Processos Grupais , Planejamento de Assistência ao Paciente/organização & administração , Competência Cultural , Avaliação Educacional , Escolaridade , Humanos , Negociação , Cuidados Paliativos/organização & administração , Cuidados Paliativos/psicologia , Prognóstico , Estudantes de Medicina/psicologia , Assistência Terminal/organização & administração , Assistência Terminal/psicologia
10.
Am J Hosp Palliat Care ; 34(9): 825-830, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27821679

RESUMO

CONTEXT: Dying is a natural process, yet physicians are often uncomfortable caring for dying patients. Learners have limited exposure to curriculum on caring for dying patients and often navigate these encounters without appropriate skills and confidence. We developed and implemented the Double Parallel Curriculum in Palliative Care (DP-PC): End-of-Life (EOL) module. The DP-PC focuses on teaching third-year medical students (MS3) to not only take care of patients in their last hours of life but give learners the confidence to teach patient's families what to expect as they hold vigil at their loved one's bedside. OBJECTIVES: To develop and implement an educational intervention that improves learners' knowledge and confidence in EOL patient and family care. To expand learner confidence to a dual level (learners become teachers) with a simplified and culturally sensitive electronic bedside teaching tool designed to guide learners and patients/families conversations. METHODS: Curriculum was completed during MS3 ambulatory rotation and included pre-/posttests, an online case-based module, faculty demonstration, and learner role-play using the bedside teaching tool. RESULTS: A total of 247 participants took the pretest, 222 participants took the posttest, and 222 participants matched the pre-/posttest surveys. Students' knowledge of EOL care and the confidence to teach other learners and families about EOL care significantly improved after completing the curriculum. CONCLUSION: The DP-PC is a technology-savvy educational intervention that improves learner confidence and knowledge toward caring for dying patients and their families. Easy access, technology-based teaching tools may enhance bedside teaching of health-care learners and improve the care of patients and their families at the end of life.


Assuntos
Cuidados Paliativos/organização & administração , Educação de Pacientes como Assunto/organização & administração , Estudantes de Medicina , Ensino , Assistência Terminal/organização & administração , Adulto , Atitude Frente a Morte , Competência Cultural , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Cuidados Paliativos/psicologia , Autoimagem , Assistência Terminal/psicologia , Adulto Jovem
11.
MedEdPORTAL ; 12: 10448, 2016 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31008226

RESUMO

Introduction: End-of-life (EOL) care delivery to Latinos is a well-documented challenge. The majority of caregivers for Latino patients are family relatives, but because Latino caregivers may spend more hours in the caregiving role than other ethnic groups and are less likely to use additional available health care, caregivers can experience an increased burden. This can result in Latino elders being more vulnerable to receiving aggressive care. "Caregivers Like Me" was created as a source for nonprofessional caregivers to improve their knowledge about Latino caregiving of elders at end-of-life (EOL). This resource aims to educate about caregiver stress and to improve attitudes towards the utilization of EOL services. Methods: "Caregivers Like Me" is a bilingual education intervention that includes a video soap opera, or telenovela. The video is followed by discussion of hospice, palliative care, and caregiver stress definitions and ends with an explanation of services available for caregivers (i.e., social services, support groups, adult day care, chore workers, home care with or without palliative care, and respite care under hospice). Results: "Caregivers Like Me" has been demonstrated to improve Latino family caregivers' openness to receiving professional help while caring for their loved ones. Participants in a multisite cross-sectional pilot study among nonprofessional Latino caregivers (N = 145) reported active learning from the intervention and high satisfaction with the overall educational experience. Discussion: This tool provides an education format that is culturally and literacy-sensitive to Latino caregivers and effective in changing their attitude toward EOL care. It may be used by professional caregivers to educate Latino caregivers about EOL care.

12.
Am J Hosp Palliat Care ; 33(6): 527-36, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26019262

RESUMO

OBJECTIVE: This study explores the ability of a culturally sensitive and case-based education intervention, Caregivers Like Me, to improve knowledge and attitudes regarding end-of-life (EOL) resources among Latino caregivers. METHODS: A multicentered, cross-sectional study of Latino communities from different geographical regions and cultural backgrounds. An educational intervention was administered to family caregivers of Latino elders using a case-based video "telenovela" and pretest-posttest questionnaires. RESULTS: Participants (N = 145) were mostly females (79%) with mean age of 56 ± 15 years. They reported active learning from intervention (91%) and high satisfaction (92%) with educational experience. Both caregiver stress self-awareness and willingness to accept professional help improved significantly from pretest to posttest. CONCLUSION: A culturally sensitive educational intervention increased Latino caregivers' self-awareness about caregiver stress and the need to consider professional assistance for EOL care.


Assuntos
Cuidadores/educação , Competência Cultural , Conhecimentos, Atitudes e Prática em Saúde , Hispano-Americanos/educação , Assistência Terminal/organização & administração , Assistência Terminal/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Conscientização , Comportamento do Consumidor , Estudos Transversais , Família/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estresse Psicológico/psicologia , Gravação de Videoteipe
13.
Am J Hosp Palliat Care ; 33(7): 625-32, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25991568

RESUMO

This retrospective pilot study aims to evaluate the clinical impact of palliative care in the treatment of terminally ill Vietnam Veterans with a history of posttraumatic stress disorder (PTSD) versus those without PTSD, as it pertains to medications for symptom control at the end of life (EOL). Active prescriptions for benzodiazepines, hypnotics, antidepressants, and antipsychotic medications at the EOL were recorded. During EOL care, 28 (72%) participants with PTSD used these medications versus 55 (40%) of the non-PTSD participants (P = .0005). There was significant correlation between a lifetime diagnosis of PTSD with antidepressant use (P = .0002) and hypnotics (P = .0085) during EOL care but not with benzodiazepines or antipsychotics. The higher utilization of certain medication classes among participants with PTSD may indicate that PTSD treatment should continue at the EOL to improve care.


Assuntos
Antidepressivos/administração & dosagem , Antipsicóticos/administração & dosagem , Hipnóticos e Sedativos/administração & dosagem , Transtornos de Estresse Pós-Traumáticos/tratamento farmacológico , Doente Terminal , Idoso , Idoso de 80 Anos ou mais , Antidepressivos/uso terapêutico , Antipsicóticos/uso terapêutico , Comorbidade , Feminino , Humanos , Masculino , Transtornos Mentais/complicações , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente , Projetos Piloto , Estudos Retrospectivos , Apoio Social , Transtornos de Estresse Pós-Traumáticos/complicações , Estados Unidos , United States Department of Veterans Affairs , Veteranos , Guerra do Vietnã
15.
Cancer J ; 20(5): 299-305, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25299138

RESUMO

It is well known that cancer patients experience lack of sleep, which affects their symptoms and decrease their much needed energy, particularly while undergoing treatment. Insomnia, which is defined as a predominant complaint of dissatisfaction with sleep quantity or quality during different phases of the sleep cycle, could easily affect patients' quality of life and even cancer treatment outcomes. In this article, we review the current research on and treatments for insomnia, as well as explore cancer-related fatigue and its connections to sleep disorders.


Assuntos
Neoplasias/complicações , Transtornos do Sono-Vigília/etiologia , Idoso , Fadiga/etiologia , Feminino , Humanos , Prevalência , Sono/fisiologia , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Distúrbios do Início e da Manutenção do Sono/etiologia , Distúrbios do Início e da Manutenção do Sono/terapia , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/terapia , Sobreviventes
16.
Acad Med ; 89(7): 1024-31, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24979171

RESUMO

PURPOSE: Given the shortage of palliative care specialists in the United States, to ensure quality of care for patients with serious, life-threatening illness, generalist-level palliative care competencies need to be defined and taught. The purpose of this study was to define essential competencies for medical students and internal medicine and family medicine (IM/FM) residents through a national survey of palliative care experts. METHOD: Proposed competencies were derived from existing hospice and palliative medicine fellowship competencies and revised to be developmentally appropriate for students and residents. In spring 2012, the authors administered a Web-based, national cross-sectional survey of palliative care educational experts to assess ratings and rankings of proposed competencies and competency domains. RESULTS: The authors identified 18 comprehensive palliative care competencies for medical students and IM/FM residents, respectively. Over 95% of survey respondents judged the competencies as comprehensive and developmentally appropriate (survey response rate = 72%, 71/98). Using predefined cutoff criteria, experts identified 7 medical student and 13 IM/FM resident competencies as essential. Communication and pain/symptom management were rated as the most critical domains. CONCLUSIONS: This national survey of palliative care experts defines comprehensive and essential palliative care competencies for medical students and IM/FM residents that are specific, measurable, and can be used to report educational outcomes; provide a sequence for palliative care curricula in undergraduate and graduate medical education; and highlight the importance of educating medical trainees in communication and pain management. Next steps include seeking input and endorsement from stakeholders in the broader medical education community.


Assuntos
Competência Clínica/normas , Educação de Graduação em Medicina/normas , Medicina de Família e Comunidade/educação , Medicina Interna/educação , Internato e Residência/normas , Cuidados Paliativos/normas , Currículo/normas , Feminino , Humanos , Masculino
17.
Am J Hosp Palliat Care ; 31(1): 87-97, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23503564

RESUMO

BACKGROUND: Low-income and minority persons, such as Latinos, encounter substantial barriers in accessing effective end-of-life (EOL) care. This study intends to review current evidence on how to deliver EOL care to Latino elders. METHODS: Literature search in PubMed and Ovid Web sites of articles indexed in Medline (1948-2011), Cochrane (2005-2011), Embase, and PsychInfo (1967-2011) databases. Articles were included if they contained (1) study participants' race/ethnicity, (2) adults or population older than 60 years, and (3) information related to EOL care. RESULTS: A total of 64 abstracts were reviewed, and 38 articles met the inclusion criteria. After reviewing the quality of evidence, 4 themes were identified and summarized: EOL preferences, hospice, Latino culture, and caregiving. CONCLUSION: Latino elders have traditional acculturation practices, face EOL decisions with family support, and, if educated, are receptive toward hospice and caregiver support.


Assuntos
Atitude Frente a Morte/etnologia , Hispano-Americanos , Cuidados Paliativos/psicologia , Assistência Terminal/psicologia , Aculturação , Planejamento Antecipado de Cuidados , Idoso , Cuidadores/psicologia , Família/etnologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Preferência do Paciente
18.
J Support Oncol ; 11(2): 75-81, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23967495

RESUMO

It is well known that clinicians experience distress and grief in response to their patients' suffering. Oncologists and palliative care specialists are no exception since they commonly experience patient loss and are often affected by unprocessed grief. These emotions can compromise clinicians' personal well-being, since unexamined emotions may lead to burnout, moral distress, compassion fatigue, and poor clinical decisions which adversely affect patient care. One approach to mitigate this harm is self-care, defined as a cadre of activities performed independently by an individual to promote and maintain personal well-being throughout life. This article emphasizes the importance of having a self-care and self-awareness plan when caring for patients with life-limiting cancer and discusses validated methods to increase self-care, enhance self-awareness and improve patient care.


Assuntos
Empatia , Neoplasias/terapia , Médicos/psicologia , Autocuidado , Esgotamento Profissional/psicologia , Humanos , Neoplasias/psicologia
19.
Acad Psychiatry ; 36(3): 188-90, 2012 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-22751819

RESUMO

OBJECTIVE: The purpose of this study was to explore the educational potential for a collaboration between palliative medicine and psychiatry designed to improve first-year medical students' knowledge and comfort with end-of-life issues through a facilitated small-group discussion with family members of recently-deceased loved ones. METHODS: A group of 222 first-year medical students were divided into 14 small groups. Each group also consisted of two mental-health providers, one palliative-medicine interdisciplinary team member, and one family member of a recently-deceased hospice patient. A death-and-dying discussion between students and family members was facilitated by the mental-health and palliative-medicine faculty and was followed by post-activity evaluations. RESULTS: As a result of the facilitated activity, 77% of participants reported increased comfort levels and 85% reported improved knowledge of end-of-life issues. Students reporting benefit were more likely to perceive higher facilitator and family comfort levels with end-of-life discussions, better activity organization, and utility of post-encounter group discussion. CONCLUSIONS: Facilitated conversations between students and family members of recently-deceased loved ones may improve comfort and knowledge with end-of-life conversations. Future studies should explore the longer-range impact of this educational activity.


Assuntos
Currículo , Morte , Educação de Graduação em Medicina/métodos , Cuidados Paliativos na Terminalidade da Vida/psicologia , Estudantes de Medicina/psicologia , Comunicação , Família/psicologia , Humanos , Estudos Retrospectivos , Assistência Terminal/psicologia
20.
J Palliat Med ; 15(1): 116-22, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22268408

RESUMO

Major efforts have been pursued to improve palliative care education for physicians at all levels of their training. Such changes include the incorporation of palliative care curriculum and guidelines, an established process for competency-based evaluation and certification, faculty development, innovative educational experiences, the improvement of textbooks, and the establishment of accredited palliative medicine fellowships. Hospice and palliative medicine (HPM) has been clearly defined as a subspecialty and a crucial area of medical education. As innovative curricular approaches have become available to educate medical and other interprofessional trainees, this article aims to describe different models and methods applied in curriculum evaluation, tailoring such approaches to the field of palliative medicine. A stepwise process of curriculum development and evaluation is described, focusing on available curriculum evaluation competency-based tools for each level of learners. As HPM evolves and its educational programs grow, curriculum evaluation will provides invaluable feedback to institutions and programs in many ways.


Assuntos
Currículo , Educação Médica , Hospitais para Doentes Terminais , Cuidados Paliativos , Avaliação de Programas e Projetos de Saúde , Estudantes de Medicina , Humanos , Estados Unidos
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