Communication about the desire to die: Development and evaluation of a first needs-oriented training concept - A pilot study

Gerrit Frerich; Vanessa Romotzky; Maren Galushko; Stefanie Hamacher; Klaus Maria Perrar; Axel Doll; Thomas Montag; Heidrun Golla; Julia Strupp; Kerstin Kremeike; Raymond Voltz

doi:10.1017/S1478951520000097

Communication about the desire to die: Development and evaluation of a first needs-oriented training concept - A pilot study

Palliat Support Care. 2020 Oct;18(5):528-536. doi: 10.1017/S1478951520000097.

Authors

Affiliations

¹ Faculty of Medicine and University Hospital, Department of Palliative Medicine, University of Cologne, Cologne, Germany.
² Faculty of Medicine and University Hospital, Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Cologne, Germany.
³ Faculty of Medicine and University Hospital, Center for Integrated Oncology, University of Cologne, Cologne, Germany.
⁴ Faculty of Medicine and University Hospital, Clinical Trials Center Cologne (ZKS), University of Cologne, Cologne, Germany.
⁵ Faculty of Medicine and University Hospital, Center for Health Services Research Cologne (ZVFK), University of Cologne, Cologne, Germany.

PMID: 32131932
DOI: 10.1017/S1478951520000097

Abstract

Objective: Patients' desire to die (DD) is rarely discussed in palliative care (PC) due to health professionals' (HPs) feeling of uncertainty. The aim of the study was to develop and evaluate a training to increase HPs' self-confidence in responding professionally to patient's DD and to assess the feasibility of this approach.

Methods: The training course was developed via focus groups and relevant literature and refined with an advisory board. An evaluation design was developed to evaluate training outcomes and to examine feasibility. To assess self-confidence, knowledge, skills, and attitudes: (1) standardized surveys were applied at T1 (before training), T2 (directly after), and T3 (3 months later), and were analyzed by descriptive and non-parametric statistics; and (2) participants' open feedback was summarized by content.

Results: A two-day multi-disciplinary training was developed to improve self-confidence via diverse teaching methods. Twenty-four HPs from general and specialized PC were participated. Via self-rating on Likert scales at three time points, improvements were seen at T1, T2, and partly remained at T3, especially in the overall item of self-confidence in communicating with patients about their DD (means: 4.3. at T1, 5.7 at T2, and 5.9 at T3; on a 7-point scale with 1 = lowest value and 7 = highest value). Fewer improvements were found in skills (using different approaches) and attitudes (feeling less helplessness). Open feedback revealed a high appreciation for the training, especially the composition of participants, the role-play, and the overall increase of awareness of the topic.

Significance of results: The developed training on addressing DD meets a need and was perceived by the participants to be of added value. Future research should measure training effects with a validated instrument, including more participants, diverse participant groups, and a control group. Effects on patients should be assessed.

Keywords: Communication; Desire for hastened death; Desire to die; Education; Palliative care.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Curriculum / trends
Female
Focus Groups / methods
Humans
Male
Middle Aged
Needs Assessment
Pilot Projects
Professional-Patient Relations*
Qualitative Research
Right to Die*
Surveys and Questionnaires
Teaching / standards*
Teaching / statistics & numerical data