A comparison of attitudes of medical students in England and in South Africa towards patients with life-limiting illness

All medical schools in the U.K. now include teaching in palliative care in the undergraduate curriculum, and this is mirrored in Europe and the U.S.A. In South Africa, however, palliative care education and provision are not widely available. An increasing number of medical and nursing staff are invited to teach palliative care in other countries. Such teaching should, however, take into account the cultural attitudes the students have towards the care of patients with a chronic or terminal illness. Nineteen statements on attitudes were constructed, and medical students in Leicester, U.K., and in Medunsa, South Africa, were invited to respond to them using a 10-point Likert scale. The questionnaire was distributed before either cohort of students had received any teaching in this area. Students in South Africa were significantly more likely to want to work in a speciality where most patients were likely to be cured (p < 0.001) and significantly less likely to believe that caring for dying patients could be rewarding (p < 0.001). South African medical students had significantly fewer positive attitudes than had their U.K. counterparts toward patients being informed of a terminal prognosis (p < 0.001). This study indicates that cultural differences between medical students may have an effect on the teaching of care for patients with life-limiting illness. This has relevance for curriculum delivery, especially when professionals are invited to teach or develop material on palliative care for other countries.     

Attitudes toward death: a survey of nursing students.

The literature devoted to the topics of death and care of the dying is expanding rapidly. As nurses are inevitably involved in terminal illness, death and grief, their attitudes toward death and factors which affect these attitudes, are worthy of study. This report describes the results of a continuing two-year survey of one class of students in a baccalaureate nursing program. A questionnaire was used at the beginning and end of one academic year. Data were obtained regarding background experiences with death, involvement in the care of dying patients, and common ideas, concerns and feelings about death. Data from the second testing also included perceived changes in "positive" and "negative" attitudes toward death, and the relative effect on attitudes of various factors during the year. Suggestions are offered for curriculum development and research in the challenging area of death education in nursing.     

Student nurses' attitudes towards death and dying in south-east Iran

In this study, the attitudes of student nurses from Kerman and Bam in Iran towards death and caring for dying patients were compared. Two types of questionnaire were used: the DAP-R (Death Attitude Profile Revised) and FATCOD (Frommelt Attitude Towards Caring for Dying patients). The Bam student nurses, who had more experience of death due to the Bam earthquake in December 2003, were found to be less afraid of death and also less likely to give care to people at the end of life compared to their counterparts in Kerman. In both groups, those who were educated about death and dying had more positive attitudes towards caring for people who are dying than non-educated participants. The study suggests that adding palliative care education, accompanied by a reflective narrative approach, to the nursing curriculum is necessary to improve quality of care at the end of life.     

Levels of empathy in undergraduate nursing students

Empathy and absence of prejudice and stigma are instrumental in facilitating effective nurse-patient relations. This study assessed empathy levels and regard for specific medical conditions in undergraduate nursing students. A cross-sectional study was undertaken using paper-based versions of the Jefferson Scale of Physician Empathy (JSPE) and Medical Condition Regard Scale (MCRS), along with a brief set of demographic questions. Participants reported good empathy levels on JSPE. Attitudes towards intellectual disability, chronic pain, acute mental illness and terminal illness rated well on MCRS. Attitudes towards substance abuse, however, were lower. There were no significant differences between age groups, gender or year level of study. Overall results of this study were positive. Nursing students demonstrated acceptable empathy levels. Attitudes towards patients who abuse substances highlight an area that needs both further exploration and addressing. Attitudes towards mental health diagnoses were particularly favourable given that these often attract stigma and negative attitudes.     

Undergraduate nursing students' attitudes and preparedness toward caring for dying persons – A longitudinal study

Nursing education needs to prepare students for care of dying patients. The aim of this study was to describe the development of nursing students' attitudes toward caring for dying patients and their perceived preparedness to perform end-of-life care. A longitudinal study was performed with 117 nursing students at six universities in Sweden. The students completed the Frommelt Attitude Toward Care of the Dying Scale (FATCOD) questionnaire at the beginning of first and second year, and at the end of third year of education. After education, the students completed questions about how prepared they felt by to perform end-of-life care. The total FATCOD increased from 126 to 132 during education. Five weeks' theoretical palliative care education significantly predicted positive changes in attitudes toward caring for dying patients. Students with five weeks' theoretical palliative care training felt more prepared and supported by the education to care for a dying patient than students with shorter education. A minority felt prepared to take care of a dead body or meet relatives.     

Death education in medical school: A seminar on terminal illness

A seminar on terminal illness was developed by the faculty of the University of Washington School of Medicine and by health care professionals within the Seattle community. A variety of teaching strategies and learning resources was employed to accommodate the large class size (180 second-year medical students). Topics reviewed included personal attitudes toward death, patient and family reactions to dying, role of the physician, role of the clergy, children and death, medical ethics in terminal illness, aging and death, grief and mourning, symptom management, and new directions in the interdisciplinary care of terminal illness. Immediate evaluation by both students and faculty was excellent. Longer follow-up evaluation (at graduation) confirms the seminar's utility but also reveals the relatively limited contact with terminal illness experienced by most medical students.     

Factors influencing preferences for place of terminal care and of death among cancer patients and their families in Korea

Goals of work This study examined cancer patient and family member preferences—and the reasons for the preferences—regarding place of terminal care and of death.Patients and methods We constructed a questionnaire that included demographic, clinical, and support network data for 371 patients who were treated at any of the seven university hospitals or the National Cancer Center in Korea and 281 of their family members.Main results About half of the interviewed patients and half of the family members expressed a preference for the patient being cared for and dying at home. The preference reflected a wish for patients to live out their lives in privacy and to be with their family when their life ended. Those who expressed a preference to be cared for or to die in a hospital wanted to get medical treatment during the last days of life and to relieve their families of the burden of caring for them. Of the variables examined, support network factors and some sociodemographic factors (sex, family members age, and place of residence) were strongly predictive of preferences.Conclusion A majority of cancer patients preferred to receive terminal care at home. Cancer patients and family members with strong support groups were more likely to prefer the home as the place of terminal care and dying. Hence, improving support networks might increase the proportion of patients receiving home care and dying at home.     

Undergraduate training in palliative medicine in Germany: what effect does a curriculum without compulsory palliative care have on medical students' knowledge, skills and attitudes?

INTRODUCTION: The effect of a curriculum without compulsory courses in palliative medicine on students' knowledge, kills and attitudes towards the care of dying patients and decisions at the end of life was investigated. METHODS: In a cross sectional, questionnaire based survey at the medical school of Bonn 1st, 3rd and 5th year students had to grade their knowledge and skills in items concerning palliative medicine. Attitudes towards end of life decisions were queried. RESULTS: The return rate was 78%. Significant increase in self estimation of certainty comparing 1st to 5th year students were detected for the items distinction between palliative and curative medicine (p <0.001), symptom control (p <0.001), pain management (p =0.001) and communication (p =0.036). No significant differences were recorded for the items accompaniment of dying patients, breaking bad news and integration of spiritual aspects. The low overall certainty is reflected in poor knowledge. A significant decrease of the approval for euthanasia by request was evident (p =0.012). DISCUSSION: A medical curriculum without compulsory course does increase confidence in some of the core competencies in palliative care, but the overall results at the end of the training are poor. The WHO claims that palliative care has to be "compulsory in courses leading to a basic professional qualification" has still to be fulfilled in Germany. This study can serve as a baseline to evaluate the effect of mandatory courses in palliative care.