Gesine Benze

On death and dying - an exploratory and evaluative study of a reflective, interdisciplinary course element in undergraduate anatomy teaching

BackgroundTeaching in palliative care aims not only at providing students with specialized knowledge in symptom therapy in advanced disease, but also at developing a professional attitude consistent with the principles and philosophy of palliative care. Reflecting about one’s own or the patient’s death and dying is considered essential for empathic patient care. In medical education the dissection course is often the first encounter with the issue of death and dying and represents a significant emotional challenge to many medical students.Against this background we implemented a new course element in preparation for the dissection course, offering opportunity to reflect own experiences with death and dying and providing support in finding a balance between authentic empathy and pragmatic action towards deceased persons. We discuss issues such as dignity and professional distance and reason whether guided support for medical students regarding these issues might influence their future attitude as doctors caring for their patients.MethodsIn tandem, we performed a formal evaluation of the seminar and explored the students’ experiences with death and dying, their expectations and fears in the run-up to the dissection course and their attitude towards dissection.ResultsThis article describes the structure and the concept of this new interdisciplinary course element and presents the results of the formal course evaluation as well as the explorative part of the accompanying research. Medical students had broad experiences with death and dying even before the dissection course. 89.1% of students had worried about some kind of emotional stress during the dissection course before, but 61.7% stated to have actually perceived emotional stress afterwards. The willingness to donate ones own body for anatomy purposes decreased significantly during the course. The given room for reflection and discussion was appreciated by the students, who felt that the effects of this seminar might be of use even beyond the dissection course.ConclusionThis new course element successfully assisted medical students during the dissection room experience and gave opportunity to reflection and discussion on death and dying. The accompanying research confirmed the demand for support and gave insight into experiences, emotions and attitudes of medical students.

P-51 The development of a framework to personalise hydration management in cancer care: the use of non-invasive technology to evaluate fluid status and dehydration-related symptoms

Background The role of hydration in causing or alleviating suffering in patients with advanced cancer is poorly understood. The evidence for the efficacy of clinically assisted hydration in advanced cancer is limited, conflicting and inconclusive. Bioelectrical impedance vector analysis (BIVA) is an accurate validated method of assessing body composition. Previously we have used BIVA to demonstrate statistically significant relationships with hydration status and symptoms (dry mouth, thirst, taste and fatigue), physical signs (mouth moisture, sunken eyes and axilla dryness), oedema and survival in advanced cancer. Further work is needed to investigate how hydration status affects symptoms and quality-of-life in the dying phase. Aim The aim of this feasibility study is to develop the necessary methodology and advanced consent procedure to conduct hydration research assessments in dying cancer patients. Methodology This study will involve an observational longitudinal analysis using BIVA assessments to evaluate hydration and its relationship with clinical symptoms and quality-of-life. Family-caregivers experiences will be evaluated via questionnaire. Thirty patients with advanced cancer will be recruited initially from a hospital-based specialist palliative care inpatient unit. Following this recruitment from additional hospice sites will be facilitated. Results This study is supported by the Academy of Medical Sciences, the UKH Foundation, North West Cancer Research and the Liverpool Clinical Commissioning Group (CCG) Research Capability Funding (RCF) grant. Recruitment is planned to commence in early 2017. Proposed findings The outcomes of this study will determine the feasibility of the methodology and will inform the development of further work. The identification of variables that are associated with hydration in the dying will facilitate the development of a clinical hydration assessment tool. This will ultimately help to develop a framework to clinically assess and manage hydration states patients with cancer.

Self-confidence and knowledge of German ICU physicians in palliative care – a multicentre prospective study

BackgroundLittle is known about ICU physicians’ self-confidence and knowledge related to palliative care. Our objective was to investigate self-confidence and knowledge of German ICU physicians related to palliative care, and to assess the impact of work experience, gender, specialty and additional certifications in pain or palliative medicine.MethodsIn a multicentre prospective observational study ICU physicians of ten hospitals were asked to rate their self-confidence and to complete a multiple choice questionnaire for the assessment of knowledge. Beyond descriptive statistics and non-parametric tests for group comparisons, linear regression analysis was used to assess the impact of independent variable on self-confidence and knowledge. Spearman‘s rank test was calculated.Results55% of answers in the knowledge test were correct and more than half of the participants rated themselves as “rather confident” or “confident”. Linear regression analysis revealed that an additional certificate in either pain or palliative medicine significantly increased both knowledge and self-confidence, but only 15 out of 137 participants had at least one of those certificates. Relation between self-confidence and the results of the knowledge test was weak (r = 0.270 in female) and very weak (r = −0.007 in male).ConclusionsAlthough the questionnaire needs improvement according to the item analysis, it appears that, with respect to palliative care, ICU Physicians’ self-confidence is not related to their knowledge. An additional certificate in either pain or palliative medicine was positively correlated to both self-confidence and knowledge. However, only a minority of the participants were qualified through such a certificate.