Clinical trial NCT03186274: Discussing Death and Dying: An End of Life Curriculum to Empower Residents
Official title: Discussing Death and Dying: An End of Life Curriculum to Empower Residents
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Education, Medical
Education, Medical, Graduate
Care, Palliative
Medicine, Palliative
Lead sponsor: Vanderbilt University Medical Center
Sponsor class: OTHER
First posted: 2017-06-14
Enrollment: 37
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: This study will evaluate how the educational intervention utilized affects pediatric resident comfort level with EOL discussions.

Detailed description: One of the most challenging roles a physician can serve is delivering life altering and/or bad news to patients and their families, and yet this skill is not widely taught to physicians. A survey from 2003 of pediatric residents found that not only was there minimal education and training in this area, but that they felt there was no natural improvement in their skills from the first to third year of training. It has also been shown that the art of eliciting a patient or family's concerns about death and responding to them is felt to be poorly taught. Worse, residents have indicated that a hidden curriculum in medicine seems to indicate that there is no value to these conversations at all. Residents are not the only stakeholders involved who have expressed concern with this reality. Parents of pediatric patients have repeatedly reported wanting increased sensitivity and clarity during sharing of life-altering information. Up to 75% of parents have reported a negative experience involving end of life (EOL) discussions, and cited inexperience, lack of comfort in communication, and a lack of knowledge as contributing factors to their negative experiences. Less than 18% of students and residents report receiving formal education in EOL discussions, despite the fact that 90% or more of residents have identified caring for those dying as part of a physician's responsibilities. Of residents who do get experience with EOL discussions, less than 2/3 receive feedback. Some residencies, such as internal medicine, have recognized the need for formal instruction on how to have EOL discussions is needed and have implemented formal programs to answer it, and it has even become a standard expectation for many fellowships. Formal education regarding EOL has also become a standard expectation for many fellowships, including pediatric neonatology, intensive care, and hematology/oncology. Despite the evidence that there is need for formal intervention and education regarding EOL care, there has been little advancement towards implementing a formal curriculum in pediatric residency programs. Review of the literature demonstrates that only one study has developed a formal curriculum involving a method called SPIKES (Setting, Perception, Involvement, Knowledge, Empathy, and Summary) that targets pediatric residents. The initial data from this study is promising and indicates increased comfort level in residents. However, to date no study has evaluated if the method of instruction affects the resident education, an important consideration as some interventions (ex. standardized patients) are more costly and time consuming than others (ex. facilitator guided small group sessions).

Eligibility criteria: Inclusion Criteria:

* Post Graduate Year (PGY) 2 or PGY-3 resident participating in the already-required Advocacy rotation at Monroe Carrell Jr. Children's Hospital at Vanderbilt
* Availability to participate in self reflection essays and simulated patient case
* English speaking

Exclusion Criteria:

* Medical students, PGY-1, PGY-4 or PGY-5 residents, fellows or learners not participating in the already-required Advocacy rotation
* Inability to participate in self reflection essays and simulated patient case
* Non-English speaking

Primary outcomes:
measure: Self-reported resident competency
timeFrame: 1 year
Secondary outcomes:
Other outcomes:
Locations:
city: Nashville
country: United States
facility: Monroe Carell Junior Children's Hospital at Vanderbilt
state: Tennessee
Study officials:
affiliation: Pediatric Hospital Medicine
name: Travis Crook, MD
role: STUDY_CHAIR
References:
citation: Tait GR, Hodges BD. Residents learning from a narrative experience with dying patients: a qualitative study. Adv Health Sci Educ Theory Pract. 2013 Oct;18(4):727-43. doi: 10.1007/s10459-012-9411-y. Epub 2012 Oct 6.
citation: Wolfe AD, Denniston SF, Baker J, Catrine K, Hoover-Regan M. Bad News Deserves Better Communication: A Customizable Curriculum for Teaching Learners to Share Life-Altering Information in Pediatrics. MedEdPORTAL. 2016 Aug 12;12:10438. doi: 10.15766/mep_2374-8265.10438.
citation: Sullivan AM, Lakoma MD, Block SD. The status of medical education in end-of-life care: a national report. J Gen Intern Med. 2003 Sep;18(9):685-95. doi: 10.1046/j.1525-1497.2003.21215.x.
citation: Keefer P, Pituch K, Murphy T, et al. A child's last hours - multidisciplinary training in end-of-life care for professionals working in children's hospitals: newborn with lethal congenital anomalies. MedEdPORTAL Publications. 2015;11:10108. http://doi.org/10.15766/mep_2374-8265.10108
citation: Rock L, Gadmer N, Arnold R, et al. Critical care communication skills training for internal medicine residents. MedEdPORTAL Publications. 2015;11:10212. http://doi.org/10.15766/mep_2374-8265.10212
citation: Brock K, Cohen H, Sourkes B, et al. Teaching pediatric fellows palliative care through simulation and video intervention: a practical guide to implementation. MedEdPORTAL Publications. 2015;11:10284. http://doi.org/10.15766/mep_2374-8265.10284
citation: Brown C, Gephardt G, Lloyd C, Swearingen C, Boateng B. Teaching palliative care skills using simulated family encounters. MedEdPORTAL Publications. 2011;7:8507. http://doi.org/10.15766/mep_2374-8265.8507
citation: Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009 Apr;42(2):377-81. doi: 10.1016/j.jbi.2008.08.010. Epub 2008 Sep 30.
citation: Jackson J, Albertini L. Caring for children with chronic health care needs: an introductory curriculum for pediatric residents. MedEdPORTAL Publications. 2012;8:9172. http://doi.org/10.15766/mep_2374-8265.9172
citation: Mintzer M, Chen A, Conway Copper T, et al. Breaking bad news using role playing: a multimedia instructional activity for teaching medical trainees. MedEdPORTAL Publications. 2014;10:9798. http://doi.org/10.15766/mep_2374-8265.9798
citation: Reichert J, Parmelee D, Bognar S, Durgans K, Godoy M. A LION IN THE HOUSE module for health care education: pediatric end-of-life case studies. MedEdPORTAL Publications. 2012;8:8362. http://doi.org/10.15766/mep_2374-8265.8362
citation: Williams D, Fisicaro T, Hargraves R, Berg D. End-of-life communication education program for internal medicine residents. MedEdPORTAL Publications. 2009;5:7945. http://doi.org/10.15766/mep_2374-8265.7945
citation: Anspacher M, Shah N. Palliative care for the medically complex child. MedEdPORTAL Publications. 2013;9:9538. http://doi.org/10.15766/mep_2374-8265.9538