Palliative Care in the Caribbean: Short Course Improves Self-assessed Competency
Key findings
- In November 2018, faculty at Massachusetts General Hospital helped lead a one-week training workshop in palliative care (PC) in Jamaica that drew 83 clinicians from five Caribbean countries and led to plans for concrete changes in clinicians' practice
- The course was well received; all participants who completed a post-course survey ranked the instruction as being of "very high" or "high" quality
- 100% of respondents planned to change their teaching practices, 96% expected to change their clinical practices, 58% anticipated doing research related to PC and 58% want to work with their administrative leadership to improve PC practice
- On a retrospective pre- and post-course self-assessment, all participants improved by at least one point (seven-point Likert scale) on each core competency in palliative care
- The leaders of this workshop are now working towards the implementation of a formal diploma program in palliative care to be offered in Jamaica for clinicians from across the Caribbean
The need for palliative care (PC) in the Caribbean is enormous because of high rates of cancer and HIV infection, yet clinicians working in PC are incredibly rare. Jamaica, with a population of nearly three million, has only one clinician with specialized training in PC, and many other nations in the region have no PC activity or only isolated PC provision.
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Bethany-Rose Daubman, MD, and Mark Stoltenberg, MD, MPH, attending physicians in the Division of Palliative Care and Geriatric Medicine at Massachusetts General Hospital, Alexandra E. Shields, PhD, director of the Harvard/Mass General Center on Genomics, Vulnerable Populations, and Health Disparities, and colleagues are part of an effort of the Jamaica Cancer Care and Research Institute (JACCRI) to provide PC training to clinicians throughout the Caribbean.
In the Journal of Pain and Symptom Management, they describe a recent intensive workshop, its favorable outcomes and plans for the future.
Preparing for the Workshop
The steering committee for the workshop comprised faculty from the University of the West Indies, Hope Institute Hospital in Jamaica and Harvard Medical School. The goals for the training were to comprehensively review selected curricular milestones of the American Academy of Hospice and Palliative Medicine, model PC's interdisciplinary perspective, and tailor the training to local cultures and norms.
Based on participant feedback from JACCRI's inaugural workshop, held in October 2017, interactive training modalities such as small group discussions were included in the 2018 course. Lecturing faculty came from primary care, nursing, oncology, pharmacology, pathology, chaplaincy, public policy and health services research.
The workshop was advertised through the Jamaican medical, nursing and pharmacy associations; the Caribbean Palliative Care Association; and print and television media. Clinicians were invited to attend regardless of discipline, practice setting or previous palliative care training. JACCRI provided financial support as needed.
Workshop Participants
The 83 participants came from five countries: Jamaica, Barbados, Turks and Caicos, Belize, and Trinidad and Tobago. 55 were physicians, 26 were nurses and 2 were pharmacists. 24% had no prior training in PC.
Participant Satisfaction
30 participants completed a post-course survey. All ranked the quality of the course as "very high" or "high." 60% were satisfied with the range of topics offered; the others expressed a desire for more instruction about care of the imminently dying patient, the interdisciplinary nature of PC and care of non-cancer patients, particularly surgical patients.
Influence on Practice
All participants who completed the survey planned to change their teaching practices, particularly increasing basic PC teaching for colleagues. 96% expected to change their clinical practices, including systemic changes such as the creation of a PC unit. 58% anticipated doing research related to PC and 58% want to work with their administrative leadership to improve PC practice.
44% of respondents cited barriers to changing their practices besides time and financial constraints. Two commonly cited were lack of formal PC training in their country and lack of awareness of PC among colleagues.
Self-assessment
On a retrospective pre- and post-course self-assessment, all participants improved by at least one point (seven-point Likert scale) on each core competency. The largest mean improvements were in the ability to identify patients who would benefit from PC, assess and manage dyspnea, assess and manage psychosocial suffering, and advocate for the advancement of PC within their healthcare system.
Future Directions
It appears the core concepts of PC translate across countries that have similar patient demographics and clinical characteristics. Hopefully, the participant feedback from this workshop will be helpful to others developing and conducting training about PC, a service that's desperately needed in a wide variety of low- and middle-income countries around the world.
The collaborative team plans to offer further PC training throughout the Caribbean. The interprofessional makeup of the training will be preserved because it reflects the nature of PC delivery, particularly in countries where for now a majority of PC will continue to be provided by non-specialists and, indeed, non-physicians.
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Learn more about the Mass General Global Palliative Care Program
Learn more about the Harvard/Mass General Center on Genomics, Vulnerable Populations, and Health Disparities