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Palliative medicine trainees be should learn about frailty: meta-synthesis and Delphi study to establish curriculum content
  1. Felicity Dewhurst1,2,
  2. Barbara Hanratty1,
  3. Katherine Frew3,
  4. Paul Paes3,4,
  5. Richard Walker1,5,
  6. Catherine Barnes6,
  7. Helena Maddock7,
  8. Joanna Elverson2 and
  9. Lucie Byrne-Davis8
  1. 1 Population Health Sciences, Newcastle University, Newcastle upon Tyne, UK
  2. 2 St Oswalds Hospice, Newcastle upon Tyne, UK
  3. 3 Palliative Medicine, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
  4. 4 School of Medical Education, Newcastle University, Newcastle upon Tyne, UK
  5. 5 Geriatric Medicine, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
  6. 6 Geriatric Medicine, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
  7. 7 Geriatic Medicine, Gateshead Health NHS Foundation Trust, Gateshead, UK
  8. 8 Division of Medical Education, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
  1. Correspondence to Dr Felicity Dewhurst, Population Health Sciences, Newcastle University, Newcastle upon Tyne NE4 6BE, Tyne and Wear, UK; drfelicitywerrett{at}doctors.org.uk

Abstract

Objectives Frailty is common and highly associated with morbidity and mortality, a fact that has been highlighted by COVID-19. Understanding how to provide palliative care for frail individuals is an international priority, despite receiving limited mention in Palliative Medicine curricula or examinations worldwide. This study aimed to synthesise evidence and establish expert consensus on what should be included in a Palliative-Medicine Specialist Training Curriculum for frailty.

Methods Literature Meta-synthesis conducted by palliative medicine, frailty and education experts produced a draft curriculum with Bologna based Learning-Outcomes. A Delphi study asked experts to rate the importance of Learning-Outcomes for specialist-training completion and propose additional Learning-Outcomes. This process was repeated until 70% consensus was achieved for over 90% of Learning-Outcomes. Experts divided Learning-Outcomes into specific (for inclusion in a frailty subsection) or generic (applicable to other palliative conditions). The Delphi panel was Subject Matter Experts: Palliative-Medicine Consultants (n=14) and Trainees (n=10), representing hospital, community, hospice and care home services and including committee members of key national training organisations. A final reviewing panel of Geriatric Medicine Specialists including experts in research methodology, national training requirements and frailty were selected.

Results The meta-synthesis produced 114 Learning-Outcomes. The Delphi Study and Review by Geriatric Medicine experts resulted in 46 essential and 33 desirable Learning-Outcomes.

Conclusions This frailty curriculum is applicable internationally and highlights the complex and unique palliative needs of frail patients. Future research is required to inform implementation, educational delivery and service provision.

  • education and training
  • nursing home care
  • supportive care
  • symptoms and symptom management
  • terminal care

Data availability statement

Data are available on reasonable request. Most data are included in the paper and the appendices. Results of specific Delphi rounds are available on request and are currently stored on a secure university server.

https://doi.org/10.1136/bmjspcare-2021-003013

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    Data availability statement

    Data are available on reasonable request. Most data are included in the paper and the appendices. Results of specific Delphi rounds are available on request and are currently stored on a secure university server.

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    Footnotes

    • Contributors FD, BH, PP, KF and LB-D were responsible for the design of the research and for conducting the study. RW, CB and HM were responsible for review of the final results. FD produced the initial draft of the manuscript. All authors critically reviewed the manuscript and contributed to redrafting. All authors read and approved the final manuscript and agree to be accountable for all aspects of the work in ensuring that questions relating to the accuracy or the integrity of the work are appropriately investigated and resolved. FD is responsible for the overall content as guarantor.

    • Funding This work was completed as part of FD’s master’s in health Professions Education in association with Keele University and FAIMER. This was funded by Health Education England North East as part of the Specialty Training Programme.

    • Competing interests The authors have declared the receipt of the following financial support for this research: This work was completed as part of FD’s master’s in health Professions Education in association with Keele University and FAIMER. This was funded by Health Education England North East as part of the Specialty Training Programme.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.