Serge Daneault

Hope and Noncurative Chemotherapies: Which Affects the Other?

From the Research Centre and theService of Hematology and Oncology,University of Montreal Hospital Centre;Departments of Family Medicine,Health Administration, and Medicine,Faculty of Medicine, University ofMontreal; Maisonneuve-RosemontHospital; School of Social Work andDepartment of Psychology, Universityof Quebec at Montreal, Montreal; andFaculty of Education, University ofSherbrooke, Sherbrooke, Quebec,Canada.Submitted October 29, 2009; acceptedJanuary 11, 2010; published onlineahead of print at www.jco.org onMarch 1, 2010.Supported by Grant No. IHP-97582from the Canadian Institutes of HealthResearch.Authors’ disclosures of potential con-flicts of interest and author contribu-tions are found at the end of thisarticle.Corresponding author: Serge Daneault,MD, Unite´ des Soins Palliatifs, HoˆpitalNotre Dame, 1560 rue Sherbrooke est,Montreal, Quebec, Canada H2L 4M1;e-mail: serge.daneault.chum@ssss.gouv.qc.ca.© 2010 by American Society of ClinicalOncology0732-183X/10/2813-2310/

Barriers to end-of-life discussions among hematologists: A qualitative study:

20.00DOI: 10.1200/JCO.2009.26.8425

Description of a teaching method for research education for palliative care healthcare professionals.

Background: Integrated palliative care is correlated with earlier end-of-life discussion and improved quality of life. Patients with haematological malignancies are far less likely to receive care from specialist palliative or hospice services compared to other cancers. Aim: The main goal of this study was to determine hematologists’ barriers to end-of-life discussions when potentially fatal hematological malignancies recur. Design: Qualitative grounded theory study using individual interviews. Setting/participants: Hematologists (n = 10) from four hematology units were asked about their relationships with their patients and their attitudes toward prognosis and end-of-life discussions at the time of recurrence. Results: As long as there are potential treatments, hematologists fear that end-of-life discussions may undermine their relationship and the patient’s trust. Because of their own representations, hematologists have great difficulty opening up to their patients’ end-of-life wishes. When prognosis is uncertain, negative outcome, that is, death, is not fully anticipated. Persistent hope silences the threat of death. Conclusion: This study reveals some of the barriers clinicians face in initiating early discussion about palliative care or patients’ end-of-life care plan. These difficulties may explain why early palliative care is little integrated into the hematology care model.

The nature of suffering and its relief in the terminally ill: a qualitative study.

OBJECTIVE Despite the rapidly growing availability of palliative care services, there is still much to be done in order to better support clinicians who are starting research programs. Among the barriers identified in the literature, methodological issues and lack of research training programs are often reported. Our aim was to describe an educational research method for healthcare professionals working in palliative care and to report the result of a survey conducted among a three-year sample of students. METHOD The course was provided for a multidisciplinary group and was open to all healthcare professionals involved in palliative care. It took place over a single session during a full day. We used a 20-question e-survey to assess student outcomes (e.g., satisfaction, current status of their project). RESULTS We received answers from 83 of the 119 students (70%) who took the course. The majority were physicians (n = 62, 75%), followed by nurses (n = 17, 21%). During the class, students assessed the role of the teacher as an information provider (n = 51, 61%), role model (n = 36, 43%), and facilitator (n = 33, 40%), and considered all of these roles as suitable, with a score of 3.9-4.7 out of 5. Participants reported a high level of support from the teacher, with a mean score of 8.2 (SD, 1.7) out of 10, and good overall satisfaction with a mean score of 7.6 (1.8). Finally, 51 participants (77%) were able to start their research project after the class, 27 (41%) to complete it, and 8 (12%) to submit their research to a journal or conference. SIGNIFICANCE OF RESULTS Our results suggest that newer teaching methods such as roleplay, group work, and target acquisition are feasible and effective in a palliative research curriculum. Additional studies are needed to confirm the objective outputs of educational interventions, including research outputs.