End of Life Care: Review of the Educational Literature

1. End of Life Care: Review of the Educational Literature Dave Pulsford Senior Lecturer School of Health University of Central Lancashire dpulsford@uclan.ac.uk

2. Nature of the Literature • Large number of papers published in last decade • Majority of authors from USA, but range of other countries represented (including UK) • Two broad types of paper: • Studies identifying staff attitudes regarding preparedness for End of Life Care, and related education and training needs, • Studies describing and evaluating specific education or training interventions.

3. Studies identifying Staff Preparedness & Education/Training Needs • Groups studied include medical students and junior doctors; student nurses and nurses in a range of specialities, also social workers. • Education needs identified include: symptom control, pain management, communicating with patients about end of life care, assisting patients’ decision making, prolonging life versus quality of life, nutrition, complementary therapies, spirituality and professionals’ coping strategies for working with dying patients.

4. Studies evaluating specific Education/Training Interventions • Range of educational initiatives included: short courses/study days, ward-based study sessions, blended/e-learning courses • Most courses were for medical or nursing staff (students or qualified); • Afew for unqualified care staff or other professional groups • Few multi-disciplinary audiences

5. Studies evaluating specific Education/Training Interventions (2) • Content of courses reflected current perceived educational needs, in particular interpersonal aspects of EOL care • Learning methods predominantly participatory and interactive (case-study discussion, role-play, etc) • Means of evaluation of learning included: course evaluation forms, knowledge questionnaires, self-reports of behaviour change, assessment of interpersonal skills. • Some studies compared pre-and post- course, or included a control condition

6. Studies evaluating specific Education/Training Interventions (3) • Outcomes included: improved attitudes towards EOL care, better preparedness for EOL Care, increased knowledge and confidence, reduced death anxiety • Some studies reported no improvement following educational input: – related to prior experience of participants and level of practice-based support, learning and supervision that participants had to reinforce classroom based input

7. Conclusion • Classroom-based education in End of Life care is highly useful to practitioners, and may be essential, but it is insufficient for changing practice without experience, support and supervision “in the field”