ABSTRACT
Introduction: Palliative care (PC) is one of 14 topics in internal medicine included in the bedside teaching course in the fourth year of medical school at the University Medical Centre of Mainz. Usually all medical students attend a 90-minute teaching session at the PC ward. Due to the COVID-19 Pandemic bedside teaching was interrupted in spring 2020. Methods: Bedside teaching was replaced by a 60-minute synchronous online teaching session on a video conference platform. After introductory discussion of core PC issues the teacher (one out of a group of 4 experienced PC-physicians) demonstrated a 17 minute video-recorded interview with a patient 10 days before her death by sharing his screen. The interview focussed on the present situation of the patient with deep insights in her coping with the terminal phase of her cancer disease. Online teaching was complemented by a virtual tour of the PC ward for download from an electronic learning platform. At the end of the term students were asked to fill out an online survey consisting of 4 single-choice questions and space for free-text remarks. Results: During the term of summer 2020 a total of 173 medical students participated in the online teaching provided in 18 sessions (9 - 10 participants per session). The online survey was returned by 59 students (34%). 24 (41%) rated the session with 10 of 10 possible points on a numeric rating scale, 13 (22%) and 12 (20%) gave 9 resp. 8 points. Learning success was rated 7 points or more by 46 students (78%). Only six students (10%) gave a rating of 4 points or less. Regarding interaction with the teacher during the online session compared to face to face teaching 20 of 55 respondents (36%;4 missings) reported no difference , 6 (11%) considered interaction even easier, while 26 (47%) perceived it as somewhat more difficult and only 3 as much more difficult. 51 of 55 students agreed that the online session had increased their interest in PC. An abundance of positive free-text remarks confirmed the favourable evaluation and highlighted the central role of the video-recorded patient interview. Conclusion: An online teaching session in PC with integration of a video- recorded interview with a terminally ill patient is positively rated by medical students and increases their interest for PC. In view of the vulnerability of terminally ill patients the use of video-recorded interviews could also be useful for post-COVID pandemic teaching.
ABSTRACT
Background: During humanitarian crises like a pandemic, healthcare systems worldwide face unknown challenges. It is likely that the COVID-19 pandemic (C-pandemic) affects care structures and processes in palliative care and thus the patients cared for. Little is known about the situation of non-COVID-19 palliative patients during the pandemic. Aim: The study aims to explore and describe the effect of the current C-pandemic on the needs of patients without a COVID-19 diagnosis and their relatives in palliative care units and specialist palliative home care. Methods: Qualitative, semi-structured interviews with patients and their relatives in palliative care units or specialist palliative home care, verbatim transcription, and qualitative content analysis following the framework approach. The framework is developed inductively. Results: 31 interviews were conducted with patients/relatives (16/15) in palliative care units/specialist palliative home care (20/11) from June 2020-January 2021. Identified needs are mostly independent of the C-pandemic and correspond to those arising from a palliative life situation in general. Themes related to the C-pandemic were (1) concerns about an infection, (2) concerns about the overall social situation, and (3) effects of the pandemic on general care. We identified a change in the relatives' role as caregivers: Restriction on visits limit relatives to fulfill their role in palliative care units. In specialist palliative home care, relatives are concerned about the balance between preserving social contacts at the end of life and preventing infection by reducing social contacts. Conclusion: Needs at the end of life remain identical in the context of the C-pandemic but become more multifaceted as additional C-pandemic needs emerge. With regard to the C-pandemic special attention should be given to the needs of relatives as caregivers.