Hostname: page-component-76fb5796d-skm99 Total loading time: 0 Render date: 2024-04-30T03:01:44.564Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  05 March 2020

Gerrit Frerich Open the ORCID record for Gerrit Frerich [Opens in a new window] ,
Vanessa Romotzky Open the ORCID record for Vanessa Romotzky [Opens in a new window] ,
Maren Galushko ,
Stefanie Hamacher ,
Klaus Maria Perrar ,
Axel Doll ,
Thomas Montag ,
Heidrun Golla ,
Julia Strupp  and
Kerstin Kremeike
...Show all authors
Gerrit Frerich*
Affiliation:
Faculty of Medicine and University Hospital, Department of Palliative Medicine, University of Cologne, Cologne, Germany
Vanessa Romotzky
Affiliation:
Faculty of Medicine and University Hospital, Department of Palliative Medicine, University of Cologne, Cologne, Germany
Maren Galushko
Affiliation:
Faculty of Medicine and University Hospital, Department of Palliative Medicine, University of Cologne, Cologne, Germany
Stefanie Hamacher
Affiliation:
Faculty of Medicine and University Hospital, Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Cologne, Germany
Klaus Maria Perrar
Affiliation:
Faculty of Medicine and University Hospital, Department of Palliative Medicine, University of Cologne, Cologne, Germany
Axel Doll
Affiliation:
Faculty of Medicine and University Hospital, Department of Palliative Medicine, University of Cologne, Cologne, Germany
Thomas Montag
Affiliation:
Faculty of Medicine and University Hospital, Department of Palliative Medicine, University of Cologne, Cologne, Germany
Heidrun Golla
Affiliation:
Faculty of Medicine and University Hospital, Department of Palliative Medicine, University of Cologne, Cologne, Germany
Julia Strupp
Affiliation:
Faculty of Medicine and University Hospital, Department of Palliative Medicine, University of Cologne, Cologne, Germany
Kerstin Kremeike
Affiliation:
Faculty of Medicine and University Hospital, Department of Palliative Medicine, University of Cologne, Cologne, Germany
Raymond Voltz
Affiliation:
Faculty of Medicine and University Hospital, Department of Palliative Medicine, University of Cologne, Cologne, Germany Faculty of Medicine and University Hospital, Center for Integrated Oncology, University of Cologne, Cologne, Germany Faculty of Medicine and University Hospital, Clinical Trials Center Cologne (ZKS), University of Cologne, Cologne, Germany Faculty of Medicine and University Hospital, Center for Health Services Research Cologne (ZVFK), University of Cologne, Cologne, Germany
*
Author for correspondence: Gerrit Frerich, Department of Palliative Medicine, University Hospital of Cologne, Cologne, Germany. E-mail: gerrit.frerich@uk-koeln.de
Get access Rights & Permissions [Opens in a new window]

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

CommunicationDesire for hastened deathDesire to dieEducationPalliative care
Type
Original Article
Information
Palliative & Supportive Care , Volume 18 , Issue 5 , October 2020 , pp. 528 - 536
Check for updates
Copyright
Copyright © Cambridge University Press 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

Both authors contributed equally to this work.

References

Bandura, A (1977) Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review 84(2), 191–215.CrossRefGoogle Scholar
Biggs, J and Tang, C (2011) Teaching for quality learning at university. New York: McGraw-Hill Education.Google Scholar
Browall, M, Henoch, I, Melin-Johansson, C, et al. (2014) Existential encounters: Nurses’ descriptions of critical incidents in end-of-life cancer care. European Journal of Oncology Nursing 18(6), 636–644.CrossRefGoogle ScholarPubMed
Dean, M and Street, RL Jr. (2014) A 3-stage model of patient-centered communication for addressing cancer patients’ emotional distress. Patient Education and Counseling 94(2), 143–148.CrossRefGoogle ScholarPubMed
Fallowfield, LJ, Jenkins, VA and Beveridge, HA (2002) Truth may hurt but deceit hurts more: Communication in palliative care. Palliative Medicine 16(4), 297–303.CrossRefGoogle ScholarPubMed
Favre, N, Despland, J-N, de Roten, Y, et al. (2007) Psychodynamic aspects of communication skills training: A pilot study. Supportive Care in Cancer 15(3), 333–337.CrossRefGoogle ScholarPubMed
Fillion, L, Duval, S, Dumont, S, et al. (2009) Impact of a meaning-centered intervention on job satisfaction and on quality of life among palliative care nurses. Psycho-Oncology 18(12), 1300–1310.CrossRefGoogle ScholarPubMed
Flick, U, von Kardoff, E and Steinke, I (eds) (2004) A companion to qualitative research. London: Sage Publications Ltd.Google Scholar
Frommelt, KH (1991) The effects of death education on nurses’ attitudes toward caring for terminally ill persons and their families. American Journal of Hospice and Palliative Care 8(5), 37–43.CrossRefGoogle ScholarPubMed
Frommelt, KH (2003) Attitudes toward care of the terminally ill: An educational intervention. American Journal of Hospice and Palliative Care 20(1), 13–22.CrossRefGoogle ScholarPubMed
Galushko, M, Romotzky, V and Voltz, R (2012) Challenges in end-of-life communication. Current Opinion in Supportive and Palliative Care 6(3), 355–364.CrossRefGoogle ScholarPubMed
Galushko, M, Frerich, G, Perrar, K, et al. (2015) Desire for hastened death: How do professionals in specialized palliative care react? Psycho-Oncology 25(5), 536–543.CrossRefGoogle ScholarPubMed
Gratz, M, Paal, P, Emmelmann, M, et al. (2015) Spiritual care in the training of hospice volunteers in Germany. Palliative and Supportive Care 14(5), 532–540.CrossRefGoogle ScholarPubMed
Hagen, T, Roser, T, Reigber, H, et al. (2011) Qualifizierungskurs Palliative Care für Seelsorgende. Curriculum und Einführung. Stuttgart: Kohlhammer.Google Scholar
Harris Keith, M and Goh Melissa, T-T (2016) Is suicide assessment harmful to participants? Findings from a randomized controlled trial. International Journal of Mental Health Nursing 26(2), 181–190.CrossRefGoogle Scholar
Henoch, I, Danielson, E, Strang, S, et al. (2013) Training intervention for health care staff in the provision of existential support to patients with cancer: A randomized, controlled study. Journal of Pain and Symptom Management 46(6), 785–794.CrossRefGoogle ScholarPubMed
Henoch, I, Strang, S, Browall, M, et al. (2015) Development of an existential support training program for healthcare professionals. Palliative and Supportive Care 13(6), 1701–1709.CrossRefGoogle ScholarPubMed
Hoffer, A and Buie, DH (2016) Helplessness and the analyst's war against feeling it. The American Journal of Psychoanalysis 76(1), 1–17.CrossRefGoogle Scholar
Hudson, PL, Schofield, P, Kelly, B, et al. (2006) Responding to desire to die statements from patients with advanced disease: Recommendations for health professionals. Palliative Medicine 20(7), 703–710.CrossRefGoogle ScholarPubMed
Kern, M, Müller, M and Aurnhammer, K (2007) Basiscurriculum palliative care: eine Weiterbildung für Pflegende in palliative care. Bonn: Pallia-Med-Verlag.Google Scholar
Kern, DE, Thomas, PA, Hughes, MT, et al. (2008) Curriculum development for medical education. A six-step approach. Baltimore, MD: The John Hopkins University Press.Google Scholar
Lapierre, S, Boyer, R, Desjardins, S, et al. (2012) Daily hassles, physical illness, and sleep problems in older adults with wishes to die. International Psychogeriatrics 24(2), 243–252.CrossRefGoogle ScholarPubMed
Lindner, R, Foerster, R and von Renteln-Kruse, W (2013) Physical distress and relationship problems: Exploring the psychosocial and intrapsychic world of suicidal geriatric patients. Zeitschrift fur Gerontologie und Geriatrie 47(6), 502–507.CrossRefGoogle Scholar
Monforte-Royo, C, Villavicencio-Chavez, C, Tomas-Sabado, J, et al. (2012) What lies behind the wish to hasten death? A systematic review and meta-ethnography from the perspective of patients. PLoS One 7(5), e37117.CrossRefGoogle Scholar
Morita, T, Murata, H, Hirai, K, et al. (2007) Meaninglessness in terminally ill cancer patients: A validation study and nurse education intervention trial. Journal of Pain and Symptom Management 34(2), 160–170.CrossRefGoogle ScholarPubMed
Morita, T, Murata, H, Kishi, E, et al. (2009) Meaninglessness in terminally ill cancer patients: A randomized controlled study. Journal of Pain and Symptom Management 37(4), 649–658.CrossRefGoogle ScholarPubMed
Morita, T, Tamura, K, Kusajima, E, et al. (2014) Nurse education program on meaninglessness in terminally ill cancer patients: A randomized controlled study of a novel two-day workshop. Journal of Palliative Medicine 17(12), 1298–1305.CrossRefGoogle ScholarPubMed
Müller, M, Kern, M, Nauck, F, et al. (1997) Qualifikation hauptamtlicher Mitarbeiter: Curricula für Ärzte, Pflegende, Sozialarbeiter, Seelsorger in Palliativmedizin. Bonn: Pallia-Med-Verlag.Google Scholar
Nauck, F, Ostgathe, C and Radbruch, L (2014) Ärztlich Assistierter Suizid. Hilfe beim Sterben — keine Hilfe zum Sterben. Deutsches Ärzteblatt 111(3), 67–71.Google Scholar
Nissim, R, Emmerson, D, O'Neill, B, et al. (2016) Motivations, satisfaction, and fears of death and dying in residential hospice volunteers: A prospective longitudinal study. American Journal of Hospice and Palliative Medicine 33(4), 335–339.CrossRefGoogle ScholarPubMed
Ohnsorge, K, Gudat, H and Rehmann-Sutter, C (2014a) Intentions in wishes to die: Analysis and a typology — A report of 30 qualitative case studies of terminally ill cancer patients in palliative care. Psycho-Oncology 23(9), 1021–1026.CrossRefGoogle Scholar
Ohnsorge, K, Gudat, H and Rehmann-Sutter, C (2014b) What a wish to die can mean: Reasons, meanings and functions of wishes to die, reported from 30 qualitative case studies of terminally ill cancer patients in palliative care. BMC Palliative Care 13, 38.CrossRefGoogle Scholar
Oordt, MS, Jobes, DA, Fonseca, VP, et al. (2009) Training mental health professionals to assess and manage suicidal behavior: Can provider confidence and practice behaviors be altered? Suicide and Life-Threatening Behavior 39(1), 21–32.CrossRefGoogle ScholarPubMed
Rodin, G, Lo, C, Mikulincer, M, et al. (2009) Pathways to distress: The multiple determinants of depression, hopelessness, and the desire for hastened death in metastatic cancer patients. Social Science and Medicine 68(3), 562–569.CrossRefGoogle ScholarPubMed
Royal College of Nursing (2011) When someone asks for your assistance to die. In Royal College of Nursing (ed.), RCN Guidance on Responding to a Request to Hasten Death, London: Royal College of Nursing.Google Scholar
Sanders, S, Bullock, K and Broussard, C (2012) Exploring professional boundaries in end-of-life care: Considerations for hospice social workers and other members of the team. Journal of Social Work in End-of-Life & Palliative Care 8(1), 10–28.CrossRefGoogle ScholarPubMed
Sheahan, L and Wein, S (2010) Denial and communication. In Kissane, D, Bultz, B, Butow, P and Finlay, I (eds.), Handbook of Communication in Oncology and Palliative Care. Oxford: Oxford University Press.Google Scholar
Smucker, WD, Ditto, PH, Moore, KA, et al. (1993) Elderly outpatients respond favorably to a physician-initiated advance directive discussion. The Journal of the American Board of Family Medicine 6, 473–482.Google ScholarPubMed
Sorensen, R and Iedema, R (2009) Emotional labour: Clinicians’ attitudes to death and dying. Journal of Health Organization and Management 23(1), 5–22.CrossRefGoogle ScholarPubMed
Strang, S, Henoch, I, Danielson, E, et al. (2014) Communication about existential issues with patients close to death — nurses’ reflections on content, process and meaning. Psycho-Oncology 23(5), 562–568.CrossRefGoogle ScholarPubMed
Udo, C, Melin-Johansson, C, Henoch, I, et al. (2014) Surgical nurses’ attitudes towards caring for patients dying of cancer — A pilot study of an educational intervention on existential issues. European Journal of Cancer Care 23(4), 426–440.CrossRefGoogle Scholar
Wilson, KG, Dalgleish, TL, Chochinov, HM, et al. (2016) Mental disorders and the desire for death in patients receiving palliative care for cancer. BMJ Supportive and Palliative Care 6(2), 170–177.CrossRefGoogle ScholarPubMed
Supplementary material: File

Frerich et al. supplementary material

Appendix

Download Frerich et al. supplementary material(File)
File 22 KB