Megan Whitehead

What Influences Individuals to Engage in Advance Care Planning

Background: Advance care planning (ACP) is an underutilized process that involves thinking about what kind of life-prolonging medical care one would want should the need arise, identifying a spokesperson, and then communicating these wishes. Objective: To better understand what influences individuals to engage in ACP. Design: Three focus groups using semistructured interactive interviews were conducted with 23 older individuals from 3 diverse populations in central Pennsylvania. Results: Four categories of influences for engaging in ACP were identified: (1) concern for self; (2) concern for others; (3) expectations about the impact of ACP; and (4) anecdotes, stories, and experiences. Conclusions: The motivations for undertaking ACP that we have identified offer health care providers insight into effective strategies for facilitating the process of ACP with their patients.

An arts-based intervention at a nursing home to improve medical students' attitudes toward persons with dementia.

Purpose Emerging data suggest that students’ attitudes toward older patients may be positively affected by geriatric experiences that are not clinically based, but no known interventions have used creative arts to integrate humanistic experiences into medical student geriatric education. This 2012 study evaluated whether participating in TimeSlips, a creative group-based storytelling program involving persons with dementia, improved medical students’ attitudes toward such patients. Method The authors administered the Dementia Attitudes Scale (DAS) to 22 fourth-year medical students to evaluate the mean change in their self-reported attitudes toward persons with dementia. The authors used paired t tests or Wilcoxon signed-rank tests to analyze pre- and post-program scores on the individual items of the DAS, on the subdomains of “comfort” and “knowledge,” and on the overall scale. They used Cronbach alpha to evaluate the internal consistency and reliability of the “comfort” and “knowledge” subdomains and of the overall scale. Results Medical students’ attitudes, as measured by the significantly higher scores on 12 of the 20 items, on each of the two subdomains, and on the overall scale, showed improvement after the TimeSlips sessions. The DAS showed acceptable to good internal consistency on both subdomains and on the overall scale both pre and post session; however, the internal consistency analysis is preliminary because of small sample size. Conclusions The authors’ findings provide preliminary evidence that participation in a creative storytelling program at a nursing home improves medical students’ attitudes toward persons with dementia and adds to evidence supporting the reliability of the DAS.

Impact of Participation in TimeSlips, a Creative Group-Based Storytelling Program, on Medical Student Attitudes Toward Persons With Dementia: A Qualitative Study

PURPOSE To evaluate whether medical student participation in TimeSlips (TS), a creative group-based storytelling program, with persons affected by dementia would improve student attitudes toward this patient population. DESIGN AND METHODS Fifteen fourth-year medical students from Penn State College of Medicine participated in a month-long regimen of TS sessions at a retirement community. Student course evaluations were analyzed at the conclusion of the program to examine perceived qualitative changes in attitude. FINDINGS Qualitative data revealed insights into the manner in which student attitudes toward a geriatric patient population became more positive. IMPLICATIONS This is the first known pilot study to suggest that participation in a creative group-based storytelling program might improve medical student attitudes toward persons with dementia.

Facebook stress management group for Year 1 medical students

What problems were addressed? Stress and depression are major problems for medical students, who experience higher risk for suicide ideation, suicide and burnout, and lower quality of life than age-matched populations. Such negative emotions can have an adverse impact on learning, lead to deleterious coping methods such as alcoholism and drug use, deplete student self-care habits, and increase risk for emotional illness. Challenges intrinsic to Year 1 of medical school have been well documented. Students must adjust to new living arrangements and form healthy relationships with their classmates while coping with reduced social support from family and friends, frequently while taking rigorous science classes and working with human cadavers. This demanding curriculum is undertaken within an intense academic environment populated by outstanding peers and medical professionals. Mitigating student stress and enhancing coping skills is a critical priority for medical educators, especially during Year 1 socialisation; however, existing programmes have been challenged by shortages of time, personnel and resources. These barriers beg the question of whether there are other means – including popular online social networks such as Facebook – through which student stress and depression might be addressed. What was tried? Given that most medical students at Penn State College of Medicine (PSCOM) use social media, we received funding and institutional review board approval to design a ‘closed’ Facebook group titled ‘PSCOM+’. Content for the site was developed using feedback from medical students in Years 2–4 and by consulting the literature on stress. Over a 10-week period during which students were enrolled in classes in gross anatomy, PSCOM+ content was posted daily. This comprised: YouTube videos of older students and faculty staff describing effective strategies for coping with stress, as well as study tips; status updates and prompts that provoked discussion (e.g. ‘What kind of music lowers your stress?’); information about campus support resources; links to supportive content (e.g. relaxing music, breathing and meditation techniques, healthy eating tips); informal surveys; updates about campus events, and incentives (e.g. coupons for local activities and activities). The site was monitored by a trained mental health professional throughout the 10-week implementation to assure appropriate usage, and was deactivated at the conclusion of the gross anatomy course. What lessons were learned? Focus group evaluation demonstrated that students greatly valued the Facebook group, particularly the YouTube testimonials containing advice from older students. Archiving stress management resources on a site that allowed continuous easy access to students provided a user-friendly venue for support. The Facebook platform prompted peer-to-peer discussions about stress and engendered friendships amongst students, while also offering the benefit of anonymity. Whereas in-person stress management programmes can risk ‘stigmatising’ students amongst their peers, PSCOM+ enabled students to access stress management resources in private unless they volunteered to comment on Facebook (anonymous engagement was tracked via the number of video views on YouTube). Our experience suggests that medical schools wishing to implement stress management programming should strongly consider using a social media site such as Facebook as a delivery system, and should draw upon older, social media-savvy students to develop and publish content. These social networks can offer advantages over learning platforms such as Moodle, which may be perceived as academic and less user-friendly. Social media sites such as Facebook can be important components of a well-equipped support system for medical students.

Factors that affect decisions to receive (or not receive) life-sustaining treatment in advance care planning.

This study identifies factors that affect decisions people make regarding whether they want to receive life-sustaining treatment. It is an interpretive-descriptive study based on qualitative data from three focus groups (N = 23), representing a diverse population in central Pennsylvania. Study sites included a suburban senior center serving a primarily White, middle-class population; an urban senior center serving a frail, underserved, African American population; and a breast cancer support group. The most important factors affecting whether participants wished to receive life-sustaining medical treatment were prognosis, expected quality of life, burden to others, burden to oneself in terms of the medical condition and treatment, and effect on mental functioning and independence. Our findings contribute to the knowledge of the complex factors that influence how people make decisions about advance care planning and life-sustaining treatments. This understanding is critical if nurses are to translate the patients goals, values, and preferences into an actionable medical plan.

Evaluating an Arts‐Based Intervention to Improve Medical Student Attitudes Toward Persons with Dementia Using the Dementia Attitudes Scale

of comorbidities was 6.4 ± 2.7. The number of drugs prescribed was of 6.8 ± 3.1. Of the 150 individuals who had a MMSE score (not performed in individuals with delirium or who were noncommunicative), 29.5% had a score between 25 and 30, 64% between 11 and 24, and 6.5% between 1 and 10. One hundred forty-seven (73.5% of the population) had at least one medication in underuse; 66 (33%) had one, 53 (26.5%) had two, 19 (9.5%) had three, eight (4%) had four, and one (0.5%) had six medications omitted. The mean number of nonprescribed medications was 1.3 ± 4.2. Table 1 shows the distribution of the most commonly underprescribed but indicated medications; 65% participants with osteoporotic fracture were not treated, 64.7% of those deficient in vitamin D received no supplementation, and 49.2% of those with dementia and 22% with depression received no specific treatment. Neither angiotensin-converting enzyme inhibitors nor angiotensin-2 receptor antagonists were prescribed in 18.8% of individuals with chronic heart failure, 14.3% with atrial fibrillation did not receive oral anticoagulants, and statins and antiplatelet agents were omitted for secondary prevention in 14.4% and 10.3%, respectively. Beta-blockers were notprescribed in 4.3% of individuals with myocardial infarction.