Sheri Burns

A Systematic Review of Postgraduate Palliative Care Curricula

BACKGROUND Palliative care is part of comprehensive family practice; however, many physicians do not feel confident in the biomedical and psychosocial realms. Although improving residency training to address this is necessary, there is little consensus on the best education methods. OBJECTIVE To conduct a systematic review of postgraduate curricula in palliative care to incorporate the most effective components into a family medicine education program. METHODS Studies of palliative care curricula conducted in postgraduate medical training programs that contained an evaluative component and published since 1980 were systematically examined by investigator pairs using standard selection criteria and data collection forms. Discrepancies were resolved by consensus. The outcomes examined were communication skills, knowledge, attitudes, and comfort/confidence level. RESULTS 28 studies were included after reviewing 174 abstracts. Most studies (n = 21) used survey pre-post design with no control group. Outcomes were grouped into communication skills, knowledge and attitudes and confidence. Workshops with simulated patients or role plays improved communication skills. Relatively brief strategies such as short workshops showed objective improvements in focused knowledge areas. Either clinical rotations or multi-faceted interventions were required to produce improvements more broadly in knowledge base. Only a few studies examined the sustainability of outcomes. CONCLUSIONS An effective palliative care curriculum will need to use a multifaceted approach, incorporating a variety of intentional strategies to address the multiple competencies required. There is a need for more rigorous curricular evaluation.

Initial Pharmacist Experience with the Ontario-Based MedsCheck Program

Background: On April 1, 2007, community pharmacists in Ontario began providing a new medication review service called MedsCheck. MedsCheck is intended to help patients better understand their medication therapy, ensure that medications are being taken as prescribed and establish a medication history. This study explored the initial experiences with MedsCheck and identified barriers to and facilitators of the implementation of the service. Methods: This was a sequential, explanatory, mixed-methods study. Community pharmacists practising in Hamilton, Ontario, completed a semi-structured mailed survey. A subsample of participants also participated in a semi-structured telephone interview. Results: A total of 88 pharmacists returned the survey and 13 participated in an interview. Respondents reported that it took an average of 30 minutes (standard deviation 11.2; range 10–60 minutes) to complete a MedsCheck. Barriers to providing the service included lack of time, physical space and patient awareness of and interest in the service. Facilitators included pharmacist overlap coverage, scheduling reviews during slower times, personally inviting patients to participate, reducing paperwork and using electronic or paper-based tools. Discussion: The MedsCheck program was well received. However, numerous barriers to its implementation were identified, most notably lack of time and a workflow that is not conducive to an appointment-based, 30-minute service. Further research suggests this time estimate may be low. Changes within the pharmacy could improve the implementation of this service. Conclusion: This study provided information on how to facilitate the implementation of MedsCheck. The results of this study can help pharmacists to improve the delivery of MedsCheck or similar services in community pharmacies.

Providing evidence-based information to patients in general practice and pharmacies: what is the acceptability, usefulness and impact on drug use?

Background  A common and often integral method of delivering patient information is the use of patient guides. However, the acceptability, utility and impact of evidence‐based therapeutic guides on physicians, pharmacists and patients have not been well evaluated.

Predictors of place of death for those in receipt of home-based palliative care services in Ontario, Canada

Many cancer patients die in institutional settings despite their preference to die at home. A longitudinal, prospective cohort study was conducted to comprehensively assess the determinants of home death for patients receiving home-based palliative care. Data collected from biweekly telephone interviews with caregivers (n=302) and program databases were entered into a multivariate logistic model. Patients with high nursing costs (odds ratio [OR]: 4.3; confidence interval [CI]: 1.8–10.2) and patients with high personal support worker costs (OR: 2.3; CI: 1.1–4.5) were more likely to die at home than those with low costs. Patients who lived alone were less likely to die at home than those who cohabitated (OR: 0.4; CI: 0.2–0.8), and those with a high propensity for a home-death preference were more likely to die at home than those with a low propensity (OR: 5.8; CI: 1.1–31.3). An understanding of the predictors of place of death may contribute to the development of effective interventions that support home death.

Establishing face and content validity of the McMaster-Ottawa team observed structured clinical encounter (TOSCE)

The Objective Structured Clinical Evaluation (OSCE) has become the criterion standard for the assessment of clinical competence in undergraduate and postgraduate medical and other health profession...

Understanding Why Physicians Modify or Ignore Prescribing Guidelines

Clinical Pharmacology & Therapeutics (2003) 73, P26–P26; doi: