Background Delivery of good palliative care is a vital skill for medical trainees. Research identifies psychological burdens associated with managing dying patients, with up to 12% of junior doctors reporting features of Post-traumatic Stress Disorder. Contributing factors include unpreparedness and insufficient support.
Methods This project looks at talking about dying and how this impacts junior doctor wellbeing and palliative care delivery. Data were collected via questionnaires validated in the undergraduate population: Self Efficacy in Palliative Care Scale (SEPC) and Thanatophobia Scale. These were distributed to Core/Internal Medicine Trainees (n = 19). Phase 1 involved distribution of a book aimed at normalising dying (With the End in Mind, Kathryn Mannix); accompanied by a bookmark signposting to additional resources, including local (WMPCP) guidelines. In Phase 2, wellbeing workshops were held. Plan-Do-Study-Act cycles were implemented. A repeat questionnaire was distributed in January (n = 12) and March 2020 (n = 13).
Results By March 2020, 69% (n = 9) had read the book and 85% (n = 11) were aware of WMPCP guidelines, compared to 5% (n = 1) and 47% (n = 9) at baseline. Of those that read the book, 100% of documented (n = 8) responses indicated positive/very positive impact on their practice and wellbeing in relation to managing dying patients. Across all questions in the SEPC, there was improvement in mean self-perceived management of dying patients. Across six of seven questions in the Thanatophobia Scale, there was a small reduction in mean scores (−0.28 to −0.85), a higher score indicating greater fear of managing dying.
Conclusions Results suggest that narrative medicine may be an effective approach to support palliative care training in trainee doctors. More research is needed to explore this further in a larger cohort and in different staff groups.
Linane H, Connolly F, et al. Disturbing and distressing: a mixed methods study on the psychological impact of end of life care on junior doctors. Irish Journal of Medical Science 2019; 188:2, p633–639.
Mason S, Ellershaw J. Assessing undergraduate palliative care education: validity and reliability of two scales examining perceived efficacy and outcome expectancies in palliative care. Medical Education 2004;38:1103–1110, Appendix 1–2.
With the End in Mind: Dying, Death, and Wisdom in an Age of Denial. Kathryn Mannix, 2017.
West Midlands Palliative Care Physicians Guidelines. Available from URL: https://www.westmidspallcare.co.uk/wmpcp/
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