Palliative care experience and perceived gaps in training among transplant hepatology fellows: A national survey
Abstract 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 transpl...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Health/LWW
2022-07-01
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| Series: | Hepatology Communications |
| Online Access: | https://doi.org/10.1002/hep4.1939 |
| _version_ | 1811174087615053824 |
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| author | Maureen P. Whitsett Nneka N. Ufere Arpan Patel Judy A. Shea Christopher A. Jones Oren K. Fix Marina Serper |
| author_facet | Maureen P. Whitsett Nneka N. Ufere Arpan Patel Judy A. Shea Christopher A. Jones Oren K. Fix Marina Serper |
| author_sort | Maureen P. Whitsett |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-04-10T17:57:30Z |
| format | Article |
| id | doaj.art-9b0db440531c4c8589c29bb591c04710 |
| institution | Directory Open Access Journal |
| issn | 2471-254X |
| language | English |
| last_indexed | 2024-04-10T17:57:30Z |
| publishDate | 2022-07-01 |
| publisher | Wolters Kluwer Health/LWW |
| record_format | Article |
| series | Hepatology Communications |
| spelling | doaj.art-9b0db440531c4c8589c29bb591c047102023-02-02T17:27:39ZengWolters Kluwer Health/LWWHepatology Communications2471-254X2022-07-01671680168810.1002/hep4.1939Palliative care experience and perceived gaps in training among transplant hepatology fellows: A national surveyMaureen P. Whitsett0Nneka N. Ufere1Arpan Patel2Judy A. Shea3Christopher A. Jones4Oren K. Fix5Marina Serper6Division of Gastroenterology and Hepatology Cleveland Clinic Cleveland Ohio USALiver Center Gastrointestinal Unit Massachusetts General Hospital Boston Massachusetts USAVatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine David Geffen School of Medicine at UCLA Los Angeles California USADivision of General Internal Medicine Department of Medicine University of Pennsylvania Philadelphia Pennsylvania USADepartment of Internal Medicine Duke University School of Medicine Durham North Carolina USADivision of Gastroenterology and Hepatology University of North Carolina Chapel Hill North Carolina USADivision of Gastroenterology and Hepatology University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania USAAbstract 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.https://doi.org/10.1002/hep4.1939 |
| spellingShingle | Maureen P. Whitsett Nneka N. Ufere Arpan Patel Judy A. Shea Christopher A. Jones Oren K. Fix Marina Serper Palliative care experience and perceived gaps in training among transplant hepatology fellows: A national survey Hepatology Communications |
| 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 |
| url | https://doi.org/10.1002/hep4.1939 |
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