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Article ; Online: Development of Objectives to Inform a National Standardized Primary Palliative Care Curriculum for Health Professions Students.

Zehm, April / Smith, Sherilyn / Schaefer, Kristen G / Jonas, Danielle / Bullock, Karen / Edwards, Rebecca L / Reville, Barbara / Jaramillo, Carolina / Webb, Amy Carol / Rydberg, Jonathan / Merel, Susan E

Journal of palliative medicine

2023 Volume 26, Issue 3, Page(s) 406–410

Abstract: Introduction: ...

Abstract	Introduction:
MeSH term(s)	Humans ; Palliative Care ; Curriculum ; Health Occupations ; Hospice and Palliative Care Nursing ; Interprofessional Relations ; Students
Language	English
Publishing date	2023-01-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	1427361-5
ISSN	1557-7740 ; 1096-6218
ISSN (online)	1557-7740
ISSN	1096-6218
DOI	10.1089/jpm.2022.0396
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Article ; Online: Integrating palliative care into routine care of patients with heart failure: models for clinical collaboration.

Lewin, Warren H / Schaefer, Kristen G

Heart failure reviews

2017 Volume 22, Issue 5, Page(s) 517–524

Abstract: Heart failure (HF) affects nearly 5.7 million Americans and is described as a chronic incurable illness carrying a poor prognosis. Patients living with HF experience significant symptoms including dyspnea, pain, anxiety, fatigue, and depression. As the ... ...

Abstract	Heart failure (HF) affects nearly 5.7 million Americans and is described as a chronic incurable illness carrying a poor prognosis. Patients living with HF experience significant symptoms including dyspnea, pain, anxiety, fatigue, and depression. As the illness advances into later stages, symptoms become more intense and refractory to standard treatments, leading to recurrent acute-care utilization and contributing to poor quality of life. Advanced HF symptoms have been described to be as burdensome, if not more than, those in cancer populations. Yet access to and provision of palliative care (PC) for this population has been described as suboptimal. The Institute of Medicine recently called for better access to PC for seriously ill patients. Despite guidelines recommending the inclusion of PC into the multidisciplinary HF care team, there is little data offering guidance on how to best operationalize PC skills in caring for this population. This paper describes the emerging literature describing models of PC integration for HF patients and aims to identify key attributes of these care models that may help guide future multi-site clinical trials to define best practices for the successful delivery of PC for patients living with advanced HF.
MeSH term(s)	Cardiology/methods ; Heart Failure/therapy ; Humans ; Models, Organizational ; Palliative Care/organization & administration ; Practice Guidelines as Topic
Language	English
Publishing date	2017-03-21
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1336499-6
ISSN	1573-7322 ; 1382-4147
ISSN (online)	1573-7322
ISSN	1382-4147
DOI	10.1007/s10741-017-9599-2
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Article ; Online: Quality of death after left ventricular assist device implantation: More questions than answers.

Desai, Akshay S / Schaefer, Kristen G / Tulsky, James A / Mehra, Mandeep R

The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation

2019 Volume 38, Issue 4, Page(s) 382–384

MeSH term(s)	Heart Failure ; Heart Ventricles ; Heart-Assist Devices ; Humans ; Terminal Care
Language	English
Publishing date	2019-01-25
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	1062522-7
ISSN	1557-3117 ; 1053-2498
ISSN (online)	1557-3117
ISSN	1053-2498
DOI	10.1016/j.healun.2019.01.1307
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Article ; Online: Improving Serious Illness Communication: Testing the Serious Illness Care Program with Trainees.

Zehm, April / Scott, Erin / Schaefer, Kristen G / Nguyen, Phuong L / Jacobsen, Juliet

Journal of pain and symptom management

2021 Volume 63, Issue 2, Page(s) e252–e259

Abstract: Background: Early conversations about patients' goals and values improve care, but clinicians struggle to conduct them. The systems-based Serious Illness Care Program (SICP) helps clinicians have more, better, and earlier conversations. Central to this ... ...

Abstract	Background: Early conversations about patients' goals and values improve care, but clinicians struggle to conduct them. The systems-based Serious Illness Care Program (SICP) helps clinicians have more, better, and earlier conversations. Central to this approach is a clinician conversation guide for patient encounters. While the SICP works for practicing clinicians, it has not been tested with medical trainees. Intervention: We adapted the SICP training to emphasize assessing prognostic awareness and responding to emotion. We developed a 2.5-hour SICP workshop for medical students and medical interns that included large- and small-group work, practice with an actor, and interdisciplinary clinician facilitators. We trained 81 students and 156 interns and obtained anonymous quantitative and qualitative feedback. Outcomes: Eighty-six percent of students and 91% of residents rated the session as "very good" or "excellent" and >90% of all learners would either recommend this training or intended to apply this to their practice. Post-session learner confidence increased in all communication skills. Learners said the training provided a helpful framework and useful language for these conversations. Resident documentation of serious illness conversations in the medical record increased dramatically during the year following training commencement. Conclusions: Grounded in principles of adult learning theory, this training was rated highly by trainees and resulted in demonstrable practice change. These early learners were more flexible and willing to try this approach than practicing clinicians who tend to resist or revert to old habits. A Guide represents a new paradigm for teaching communication skills and is valued by early learners.
MeSH term(s)	Adult ; Communication ; Critical Care ; Critical Illness/therapy ; Documentation ; Humans ; Students, Medical/psychology
Language	English
Publishing date	2021-11-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	639142-4
ISSN	1873-6513 ; 0885-3924
ISSN (online)	1873-6513
ISSN	0885-3924
DOI	10.1016/j.jpainsymman.2021.10.013
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Article ; Online: A Call to Action: Using Curriculum Mapping at Four Medical Schools in Massachusetts to Advance Serious Illness Communication Training in Undergraduate Medical Education.

Reidy, Jennifer A / Chan, Stephanie H / Boelitz, Kris M / Chavez, Melissa / Clark, Melissa A / Epstein, Scott K / Gosline, Anna / Healy, Rose / Livne, Emma / Peirce, Hayden / Schaefer, Kristen G / Streid, Jocelyn / Vesel, Tamara / Young, Megan E / Zehm, April / Garg, Priya S

Journal of palliative medicine

2023 Volume 27, Issue 1, Page(s) 39–46

Abstract: Background: ...

Abstract	Background:
MeSH term(s)	Humans ; Education, Medical, Undergraduate/methods ; Schools, Medical ; Curriculum ; Massachusetts ; Communication
Language	English
Publishing date	2023-11-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	1427361-5
ISSN	1557-7740 ; 1096-6218
ISSN (online)	1557-7740
ISSN	1096-6218
DOI	10.1089/jpm.2022.0562
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Article ; Online: Left Ventricular Assist Device Withdrawal: Ethical, Psychological, and Logistical Challenges.

Slavin, Samuel D / Allen, Larry A / McIlvennan, Colleen K / Desai, Akshay S / Schaefer, Kristen G / Warraich, Haider J

Journal of palliative medicine

2020 Volume 23, Issue 4, Page(s) 456–458

MeSH term(s)	Device Removal/ethics ; Device Removal/psychology ; Heart Failure/therapy ; Heart-Assist Devices/ethics ; Heart-Assist Devices/psychology ; Humans ; Terminal Care/standards ; Treatment Outcome
Language	English
Publishing date	2020-01-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	1427361-5
ISSN	1557-7740 ; 1096-6218
ISSN (online)	1557-7740
ISSN	1096-6218
DOI	10.1089/jpm.2019.0622
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Article ; Online: Missed opportunities to train medical students in generalist palliative care during core clerkships.

Smith, Grant M / Schaefer, Kristen G

Journal of palliative medicine

2014 Volume 17, Issue 12, Page(s) 1344–1347

Abstract: Background: To improve the quality of care for dying patients, experts have called for all clinicians to be able to provide a generalist level of palliative care. Core clinical clerkships provide an opportunity to incorporate palliative care training to ...

Abstract	Background: To improve the quality of care for dying patients, experts have called for all clinicians to be able to provide a generalist level of palliative care. Core clinical clerkships provide an opportunity to incorporate palliative care training to address the lack of required palliative care rotations at most U.S. medical schools. Objective: The objective of this study was to identify and quantify missed opportunities to train third-year medical students in generalist palliative care during required core clerkships. Design: This study was a cross-sectional survey of third-year students at a leading U.S. medical school without a required palliative care rotation. Measurements: Students completed a survey during the last 4 months of the 2012-2013 academic year quantifying and evaluating their experiences caring for dying patients. Attitudes were assessed using a scale from a national survey of students, residents, and faculty. Results: Eighty-eight students responded (response rate [RR]=56%). More than one-quarter (26%) never participated in caring for a patient who died. More than one-half (55%) never delivered significant bad news and 38% never worked with a specialist in palliative medicine. Eighty-four percent of students who cared for a patient who died and 60% of students who delivered significant bad news had one or more of those experiences that were not debriefed. Conclusions: At an institution without a required palliative care rotation, third-year medical students rarely or never care for patients who die during core clerkships, and when they do, their teams do not debrief or reflect on these experiences. Clinical faculty, including palliative care consultants, can address missed opportunities for palliative care training during core clerkships by augmenting and routinely debriefing students' experiences giving bad news and caring for dying patients.
MeSH term(s)	Adult ; Attitude of Health Personnel ; Boston ; Clinical Clerkship ; Cross-Sectional Studies ; Curriculum ; Education, Medical, Undergraduate ; Female ; Humans ; Male ; Palliative Care ; Palliative Medicine/education ; Students, Medical/psychology ; Surveys and Questionnaires ; United States
Language	English
Publishing date	2014-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	1427361-5
ISSN	1557-7740 ; 1096-6218
ISSN (online)	1557-7740
ISSN	1096-6218
DOI	10.1089/jpm.2014.0107
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Article ; Online: Palliative Care and Communication Training in Neurosurgery Residency: Results of a Trainee Survey.

Miranda, Stephen P / Schaefer, Kristen G / Vates, G Edward / Gormley, William B / Buss, Mary K

Journal of surgical education

2019 Volume 76, Issue 6, Page(s) 1691–1702

Abstract: Objective: Neurosurgeons care for critically ill patients near the end of life, yet little is known about how well their training prepares them for this role. We surveyed a random sample of neurosurgery residents to describe the quantity and quality of ... ...

Abstract	Objective: Neurosurgeons care for critically ill patients near the end of life, yet little is known about how well their training prepares them for this role. We surveyed a random sample of neurosurgery residents to describe the quantity and quality of teaching activities related to serious illness communication and palliative care, and resident attitudes and perceived preparedness to care for seriously ill patients. Methods: A previously validated survey instrument was adapted to reflect required communication and palliative care competencies in the 2015 the Accreditation Council for Graduate Medical Education (ACGME) Milestones for Neurological Surgery. The survey was reviewed for content validity by independent faculty neurosurgeons, piloted with graduating neurosurgical residents, and distributed online in August 2016 to neurosurgery residents in the United States using the American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) Joint Section on Neurotrauma and Critical Care email listserv. Multiple choice and Likert scale responses were analyzed using descriptive statistics. Results: Sixty-two responses were recorded between August 2016 and October 2016. Most respondents reported no explicit teaching on: explaining risks and benefits of intubation and ventilation (69%), formulating prognoses in neurocritical care (60%), or leading family meetings (69%). Compared to performing craniotomies, respondents had less frequent practice leading discussions about withdrawing life-sustaining treatment (61% vs. 90%, p < 0.01, "weekly or more frequently"), and were less often observed (18% vs. 87%, p < 0.01) and given feedback on their performance (11% vs. 58%, p < 0.01). Nearly all respondents (95%) felt "prepared to discuss withdrawing life-sustaining treatments," however half (48%) reported they "would benefit from more communication training during residency." Most (87%) reported moral distress, agreeing that they "participated in operations and worried whether surgery aligned with patient goals." Conclusions: Residents in our sample reported limited formal training, and relatively less observation and feedback, on required ACGME competencies in palliative care and communication. Most reported preparedness in this domain, but many were receptive to more training. Better quality and more consistent palliative care education in neurosurgery residency could improve competency and help ensure that neurosurgical care aligns with patient goals.
MeSH term(s)	Adult ; Communication ; Female ; Health Care Surveys ; Humans ; Internship and Residency ; Male ; Neurosurgery/education ; Palliative Care
Language	English
Publishing date	2019-06-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	2277538-9
ISSN	1878-7452 ; 1931-7204
ISSN (online)	1878-7452
ISSN	1931-7204
DOI	10.1016/j.jsurg.2019.06.010
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Article ; Online: Paving the way for universal medical student training in serious illness communication: the Massachusetts Medical Schools' Collaborative.

Reidy, Jennifer A / Clark, Melissa A / Berman, Harris A / Chan, Stephanie H / Gawande, Atul A / Streid, Jocelyn / Vesel, Tamara / Young, Megan E / Zehm, April / Schaefer, Kristen G

BMC medical education

2022 Volume 22, Issue 1, Page(s) 654

Abstract: Background: Patients with serious illness look to their clinicians for discussion and guidance on high-stakes treatment decisions, which are complex, emotional and value-laden. However, required training in serious illness communication is rare in U.S. ... ...

Abstract	Background: Patients with serious illness look to their clinicians for discussion and guidance on high-stakes treatment decisions, which are complex, emotional and value-laden. However, required training in serious illness communication is rare in U.S. medical schools, with efforts at curricular reform stymied by competing institutional demands, lack of resources and accreditation requirements. We describe an approach to building and scaling medical student training in serious illness communication through the creation of a statewide collaborative of medical schools. Methods: The Massachusetts Medical Schools' Collaborative is a first-of-its-kind group that promotes longitudinal, developmentally-based curricula in serious illness communication for all students. Convened externally by the Massachusetts Coalition for Serious Illness Care, the collaborative includes faculty, staff, and students from four medical schools. Results: The collaborative started with listening to member's perspectives and collectively developed core competencies in serious illness communication for implementation at each school. We share early lessons on the opportunities, challenges and sustainability of our statewide collective action to influence curricular reform, which can be replicated in other topic areas. Conclusions: Our next steps include curriculum mapping, student focus groups and faculty development to guide successful and enduring implementation of the competencies to impact undergraduate medical education in Massachusetts and beyond.
MeSH term(s)	Communication ; Curriculum ; Education, Medical, Undergraduate ; Humans ; Schools, Medical ; Students, Medical/psychology
Language	English
Publishing date	2022-09-01
Publishing country	England
Document type	Journal Article
ZDB-ID	2044473-4
ISSN	1472-6920 ; 1472-6920
ISSN (online)	1472-6920
ISSN	1472-6920
DOI	10.1186/s12909-022-03702-2
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Article ; Online: Role of Palliative Care in the Outpatient Management of the Chronic Heart Failure Patient.

Chuzi, Sarah / Pak, Esther S / Desai, Akshay S / Schaefer, Kristen G / Warraich, Haider J

Current heart failure reports

2019 Volume 16, Issue 6, Page(s) 220–228

Abstract: Purpose of review: Patients with heart failure (HF) have an increased symptom burden and complex psychosocial and decision-making needs that necessitate the integration of palliative care. However, in the current era, palliative care is frequently ... ...

Abstract	Purpose of review: Patients with heart failure (HF) have an increased symptom burden and complex psychosocial and decision-making needs that necessitate the integration of palliative care. However, in the current era, palliative care is frequently evoked for these patients only at the end-of-life or in the inpatient setting; rarely is palliative care proactively utilized in outpatients with HF. The purpose of this review is to evaluate the current state of palliative care and heart failure and to provide a roadmap for the integration of palliative care into outpatient HF care. Recent findings: Recent studies, including PAL-HF, CASA, and SWAP-HF, have demonstrated that structured palliative care interventions may improve quality of life, depression, anxiety, understanding of prognosis, and well-being in HF. HF is associated with high mortality risk, significant symptom burden, and impaired quality of life. Palliative care can meet many of these needs; however, in the current era, palliative care consultations in HF occur late in the disease course and too often in the inpatient setting. Primary palliative care should be provided to all outpatients with heart failure based on their needs, with referral to secondary palliative care provided based on certain triggers and milestones.
MeSH term(s)	Advance Care Planning ; Ambulatory Care/organization & administration ; Chronic Disease ; Delivery of Health Care, Integrated/organization & administration ; Heart Failure/therapy ; Humans ; Needs Assessment/organization & administration ; Palliative Care/organization & administration ; Quality of Life
Language	English
Publishing date	2019-12-02
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2151202-4
ISSN	1546-9549 ; 1546-9530
ISSN (online)	1546-9549
ISSN	1546-9530
DOI	10.1007/s11897-019-00440-3
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