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Palliative care experience and perceived gaps in training among transplant hepatology fellows: A national survey

Despite the likely benefits of palliative care (PC) for patients with cirrhosis, physician experiences and perspectives about best practices are variable. We aimed to assess PC experience and gaps in training among transplant hepatology fellows. We conducted a national survey of all transplant hepat...

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Autores principales: Whitsett, Maureen P., Ufere, Nneka N., Patel, Arpan, Shea, Judy A., Jones, Christopher A., Fix, Oren K., Serper, Marina
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9234628/
https://www.ncbi.nlm.nih.gov/pubmed/35411683
http://dx.doi.org/10.1002/hep4.1939
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author Whitsett, Maureen P.
Ufere, Nneka N.
Patel, Arpan
Shea, Judy A.
Jones, Christopher A.
Fix, Oren K.
Serper, Marina
author_facet Whitsett, Maureen P.
Ufere, Nneka N.
Patel, Arpan
Shea, Judy A.
Jones, Christopher A.
Fix, Oren K.
Serper, Marina
author_sort Whitsett, Maureen P.
collection PubMed
description Despite the likely benefits of palliative care (PC) for patients with cirrhosis, physician experiences and perspectives about best practices are variable. We aimed to assess PC experience and gaps in training among transplant hepatology fellows. We conducted a national survey of all transplant hepatology fellows enrolled in accredited fellowship programs during the 2020–2021 academic year. We assessed the frequency of PC provision and comfort with physical and psychological symptom management, psychosocial care, communication skills, advance care planning, and end‐of‐life care. A total of 45 of 56 (79%) of transplant hepatology fellows responded to the survey; 50% (n = 22) were female. Most trained at centers performing over 100 transplants per year (67%, n = 29) distributed evenly across geographic regions. Most fellows (69%, n = 31) had a PC or hospice care rotation during residency, and 42% (n = 19) of fellows received education in PC during transplant hepatology fellowship. Fellows reported feeling moderately to very comfortable with communication skills such as breaking bad news (93%, n = 41) and leading family meetings (75%, n = 33), but nearly one‐third (30%, n = 13) reported feeling not very or not at all comfortable assessing and managing anxiety and depression (30%, n = 13) and spiritual distress (34%, n = 15). Nearly one‐quarter (22%, n = 10) had never discussed or documented advance care plans during fellowship. Fellows wished to receive future instruction on the assessment and management of physical symptoms (68%, n = 30) and anxiety and depression (64%, n = 28). Conclusion: Our survey highlights gaps in PC experience and education during transplant hepatology fellowship, lack of comfort in managing psychological distress and advance care planning, and desire to improve skills, particularly in symptom management. Future studies should investigate how to enhance transplant hepatology competencies in these PC domains and whether this impacts clinical care, advance care planning, or patient experience.
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spelling pubmed-92346282022-06-30 Palliative care experience and perceived gaps in training among transplant hepatology fellows: A national survey Whitsett, Maureen P. Ufere, Nneka N. Patel, Arpan Shea, Judy A. Jones, Christopher A. Fix, Oren K. Serper, Marina Hepatol Commun Original Articles Despite the likely benefits of palliative care (PC) for patients with cirrhosis, physician experiences and perspectives about best practices are variable. We aimed to assess PC experience and gaps in training among transplant hepatology fellows. We conducted a national survey of all transplant hepatology fellows enrolled in accredited fellowship programs during the 2020–2021 academic year. We assessed the frequency of PC provision and comfort with physical and psychological symptom management, psychosocial care, communication skills, advance care planning, and end‐of‐life care. A total of 45 of 56 (79%) of transplant hepatology fellows responded to the survey; 50% (n = 22) were female. Most trained at centers performing over 100 transplants per year (67%, n = 29) distributed evenly across geographic regions. Most fellows (69%, n = 31) had a PC or hospice care rotation during residency, and 42% (n = 19) of fellows received education in PC during transplant hepatology fellowship. Fellows reported feeling moderately to very comfortable with communication skills such as breaking bad news (93%, n = 41) and leading family meetings (75%, n = 33), but nearly one‐third (30%, n = 13) reported feeling not very or not at all comfortable assessing and managing anxiety and depression (30%, n = 13) and spiritual distress (34%, n = 15). Nearly one‐quarter (22%, n = 10) had never discussed or documented advance care plans during fellowship. Fellows wished to receive future instruction on the assessment and management of physical symptoms (68%, n = 30) and anxiety and depression (64%, n = 28). Conclusion: Our survey highlights gaps in PC experience and education during transplant hepatology fellowship, lack of comfort in managing psychological distress and advance care planning, and desire to improve skills, particularly in symptom management. Future studies should investigate how to enhance transplant hepatology competencies in these PC domains and whether this impacts clinical care, advance care planning, or patient experience. John Wiley and Sons Inc. 2022-04-11 /pmc/articles/PMC9234628/ /pubmed/35411683 http://dx.doi.org/10.1002/hep4.1939 Text en © 2022 The Authors. Hepatology Communications published by Wiley Periodicals LLC on behalf of American Association for the Study of Liver Diseases. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Articles
Whitsett, Maureen P.
Ufere, Nneka N.
Patel, Arpan
Shea, Judy A.
Jones, Christopher A.
Fix, Oren K.
Serper, Marina
Palliative care experience and perceived gaps in training among transplant hepatology fellows: A national survey
title Palliative care experience and perceived gaps in training among transplant hepatology fellows: A national survey
title_full Palliative care experience and perceived gaps in training among transplant hepatology fellows: A national survey
title_fullStr Palliative care experience and perceived gaps in training among transplant hepatology fellows: A national survey
title_full_unstemmed Palliative care experience and perceived gaps in training among transplant hepatology fellows: A national survey
title_short Palliative care experience and perceived gaps in training among transplant hepatology fellows: A national survey
title_sort palliative care experience and perceived gaps in training among transplant hepatology fellows: a national survey
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9234628/
https://www.ncbi.nlm.nih.gov/pubmed/35411683
http://dx.doi.org/10.1002/hep4.1939
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